Provider Demographics
NPI:1598854440
Name:PADILLA, ANDREA SUZANNE (PHCY TECH)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:SUZANNE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PHCY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11271 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8012
Mailing Address - Country:US
Mailing Address - Phone:530-575-0311
Mailing Address - Fax:
Practice Address - Street 1:11271 TORREY PINES DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8012
Practice Address - Country:US
Practice Address - Phone:530-575-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1646183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician