Provider Demographics
NPI:1598428591
Name:PADILLA, YVETTE MARIE
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARIE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W 3RD STREET RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-1548
Mailing Address - Country:US
Mailing Address - Phone:970-350-5330
Mailing Address - Fax:
Practice Address - Street 1:2350 W 3RD STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-1548
Practice Address - Country:US
Practice Address - Phone:970-350-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility