Provider Demographics
NPI:1639643588
Name:PADILLA, NOELANI GABRIELLE
Entity Type:Individual
Prefix:
First Name:NOELANI
Middle Name:GABRIELLE
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 1:313 LENNON LN STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2460
Mailing Address - Country:US
Mailing Address - Phone:925-289-1090
Mailing Address - Fax:925-289-1239
Practice Address - Street 1:313 LENNON LN STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2460
Practice Address - Country:US
Practice Address - Phone:925-289-1090
Practice Address - Fax:925-289-1239
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician