Provider Demographics
NPI:1679504252
Name:PADILLA, MARION J (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:J
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9452 GULSTRAND CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7903
Mailing Address - Country:US
Mailing Address - Phone:714-962-8170
Mailing Address - Fax:
Practice Address - Street 1:2600 EAST PACIFIC COAST HIGHWAY
Practice Address - Street 2:STE. M
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625
Practice Address - Country:US
Practice Address - Phone:949-640-2121
Practice Address - Fax:949-640-2631
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT6831AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER