Provider Demographics
NPI:1114628203
Name:RODRIGUEZ PADILLA, YAILIS
Entity Type:Individual
Prefix:
First Name:YAILIS
Middle Name:
Last Name:RODRIGUEZ 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 1:1115 WESLEY ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6509
Mailing Address - Country:US
Mailing Address - Phone:786-416-2014
Mailing Address - Fax:
Practice Address - Street 1:1219 SE 34TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-4291
Practice Address - Country:US
Practice Address - Phone:239-703-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty