Provider Demographics
NPI:1023040383
Name:PADILLA, EFREN
Entity Type:Individual
Prefix:MR
First Name:EFREN
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3793
Mailing Address - Country:US
Mailing Address - Phone:760-863-1572
Mailing Address - Fax:760-775-1295
Practice Address - Street 1:44925 JACKSON ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3228
Practice Address - Country:US
Practice Address - Phone:760-863-1572
Practice Address - Fax:760-775-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18416343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)