Provider Demographics
NPI:1356083828
Name:PADILLA, MICHELE CASSANDRA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:CASSANDRA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7638
Mailing Address - Country:US
Mailing Address - Phone:619-233-8500
Mailing Address - Fax:
Practice Address - Street 1:3350 E ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3332
Practice Address - Country:US
Practice Address - Phone:619-466-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020636363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health