MEDICARE: MISS CAROLINA CHRISTINE PADILLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-20-42022	FL
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46-4295619	OTHER	NY	1417364787

General Provider Information

NPI Number	:	1023525078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAROLINA CHRISTINE PADILLA

Provider Business Mailing Address
First Line	:	10910 CAMERON CT APT 101
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4165
Country	:	US
Telephone Number	:	786-405-6059
Fax Number	:

Provider Business Practice Location Address
First Line	:	1887 RICHMOND AVE STE 5
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3923
Country	:	US
Telephone Number	:	718-698-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2017
Last Update Date	:	01/02/2021

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Directions to “ MISS CAROLINA CHRISTINE PADILLA ” Practice Location

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