Provider Demographics
NPI:1669027454
Name:PADILLA, KAIRA (BA)
Entity Type:Individual
Prefix:
First Name:KAIRA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-3507
Mailing Address - Country:US
Mailing Address - Phone:909-581-5264
Mailing Address - Fax:
Practice Address - Street 1:4017 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3507
Practice Address - Country:US
Practice Address - Phone:909-581-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40000031115900Medicaid