Provider Demographics
NPI:1124583323
Name:PADILLA, MARIELA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 PERSHING DR UNIT 4321
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8017
Mailing Address - Country:US
Mailing Address - Phone:310-307-6863
Mailing Address - Fax:
Practice Address - Street 1:925 W 34TH STREET HERMAN OSTROW SCHOOL OF DENTISTRY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0001
Practice Address - Country:US
Practice Address - Phone:213-740-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60809187122300000X
CA1035111223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist