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General NPI Number Information
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NPI Number | 1750247953
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Entity Type | Individual
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Provider Name | JUSTIN ROBERTO PADILLA FERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1401 SE GOLDTREE DR STE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7584
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Country | US
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Telephone | 772-212-7539
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Fax | 772-673-8392
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Provider Business Mailing Address
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Address Line | 1533 SW DEL RIO BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1452
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Country | US
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Telephone | 772-342-5500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-497995
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License Number State | FL
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