Provider Demographics
NPI:1407239858
Name:PADILLA, JESUS ALFONSO
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALFONSO
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 1:1640 W CATALPA DR APT 11
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4108
Mailing Address - Country:US
Mailing Address - Phone:714-797-3417
Mailing Address - Fax:
Practice Address - Street 1:1525 E 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8523
Practice Address - Country:US
Practice Address - Phone:714-542-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)