Provider Demographics
NPI:1104202829
Name:PADILLA, JOSE A JR (AMFT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:PADILLA
Suffix:JR
Gender:M
Credentials:AMFT
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:BONILLA PADILLA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:790 VIA LATA STE 300
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3978
Mailing Address - Country:US
Mailing Address - Phone:909-433-0445
Mailing Address - Fax:
Practice Address - Street 1:790 VIA LATA STE 300
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3978
Practice Address - Country:US
Practice Address - Phone:909-443-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist