Provider Demographics
NPI:1003483280
Name:PADILLA, MARTIN (CPHT)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 S TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7280
Mailing Address - Country:US
Mailing Address - Phone:559-300-6360
Mailing Address - Fax:
Practice Address - Street 1:1645 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-3155
Practice Address - Country:US
Practice Address - Phone:559-688-5839
Practice Address - Fax:559-686-2470
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician