MEDICARE: DIANA A. 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	106H00000X	Marriage & Family Therapist		NY

General Provider Information

NPI Number	:	1588210678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA A. PADILLA

Provider Business Mailing Address
First Line	:	PO BOX 8233
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10602-8233
Country	:	US
Telephone Number	:	212-655-9605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6102
Country	:	US
Telephone Number	:	212-655-9605
Fax Number	:

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

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	02/21/2024

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