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General NPI Number Information
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NPI Number | 1780420984
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Entity Type | Individual
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Provider Name | JOSEPH RAUL PADILLA JR. APRN
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Gender | Male
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 140 N FRONTAGE RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1648
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Country | US
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Telephone | 860-456-2261
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Fax | 860-450-1357
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Provider Business Mailing Address
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Address Line | 140 N FRONTAGE RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1648
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Country | US
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Telephone | 604-562-2618
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Fax | 860-450-1357
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 13940
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License Number State | CT
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