Provider Demographics
NPI:1033482476
Name:PADILLA, ELOISA
Entity Type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 DALY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2230
Mailing Address - Country:US
Mailing Address - Phone:323-222-4591
Mailing Address - Fax:
Practice Address - Street 1:2309 DALY ST .
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031
Practice Address - Country:US
Practice Address - Phone:323-222-4591
Practice Address - Fax:323-222-4614
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker