Provider Demographics
NPI:1427391150
Name:PADILHA, CLOVIS JR (LICAC)
Entity Type:Individual
Prefix:
First Name:CLOVIS
Middle Name:
Last Name:PADILHA
Suffix:JR
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2429
Mailing Address - Country:US
Mailing Address - Phone:774-232-6928
Mailing Address - Fax:
Practice Address - Street 1:121 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:774-232-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA868337146N00000X
MA255748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic