Provider Demographics
NPI:1043862519
Name:PINA PADILLA, RUBIA ELENA
Entity Type:Individual
Prefix:
First Name:RUBIA
Middle Name:ELENA
Last Name:PINA 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 1:25241 SW 114TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4718
Mailing Address - Country:US
Mailing Address - Phone:786-370-1409
Mailing Address - Fax:
Practice Address - Street 1:25241 SW 114TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4718
Practice Address - Country:US
Practice Address - Phone:786-370-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician