Provider Demographics
NPI:1376086355
Name:PADILLA, MICHAEL (CPSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HAGON RD
Mailing Address - Street 2:
Mailing Address - City:SAN FELIPE PB
Mailing Address - State:NM
Mailing Address - Zip Code:87001-8087
Mailing Address - Country:US
Mailing Address - Phone:505-867-3381
Mailing Address - Fax:
Practice Address - Street 1:51 BOSQUE RD
Practice Address - Street 2:
Practice Address - City:ALGODONES
Practice Address - State:NM
Practice Address - Zip Code:87001-8014
Practice Address - Country:US
Practice Address - Phone:505-639-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician