Provider Demographics
NPI:1093362030
Name:PADILLA, TODD LARRY SR (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:LARRY
Last Name:PADILLA
Suffix:SR
Gender:M
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3906
Mailing Address - Country:US
Mailing Address - Phone:619-579-8373
Mailing Address - Fax:619-579-8155
Practice Address - Street 1:234 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3906
Practice Address - Country:US
Practice Address - Phone:619-579-8373
Practice Address - Fax:619-579-8155
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN247240164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse