Provider Demographics
NPI:1114608387
Name:PADILLA, RAFAEL ALEJANDRO DE JESUS
Entity Type:Individual
Prefix:
First Name:RAFAEL ALEJANDRO
Middle Name:DE JESUS
Last Name:PADILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 NE 110TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5183
Mailing Address - Country:US
Mailing Address - Phone:206-853-6602
Mailing Address - Fax:
Practice Address - Street 1:2527 NE 110TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5183
Practice Address - Country:US
Practice Address - Phone:206-853-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60853545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse