Provider Demographics
NPI:1083294490
Name:ASHBY PADIAL, CHRISTIAN JAVIER
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JAVIER
Last Name:ASHBY PADIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:JAVIER
Other - Last Name:LOPEZ ASHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 HARRISON AVE BLDG 4TH
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2905
Mailing Address - Country:US
Mailing Address - Phone:617-638-6604
Mailing Address - Fax:
Practice Address - Street 1:820 HARRISON AVE BLDG 4TH
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-638-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0000Medicaid