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NPI Code Detail

MEDICARE: JACOB THOMAS PADILLA ASL

MEDICARE: JACOB THOMAS PADILLA ASL
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
1235Z00000XSpeech-Language PathologistSLPA7463NM
2235Z00000XSpeech-Language PathologistSAH-2025-0068NM

General Provider Information

NPI Number : 1104553650
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB THOMAS PADILLA ASL
Provider Business Mailing Address
First Line : 301 PERKINS DR.
Second Line : STE C
City : LAS CRUCES
State : NM
Zip : 88005-3248
Country : US
Telephone Number : 575-523-7243
Fax Number : 575-525-5641
Provider Business Practice Location Address
First Line : 1090 MED PARK DR.
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3236
Country : US
Telephone Number : 575-523-7243
Fax Number : 575-525-5641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2022
Last Update Date : 01/15/2026

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Directions to “ JACOB THOMAS PADILLA ASL” Practice Location

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