Provider Demographics
NPI:1710182977
Name:PADILLA, CARLOS J
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:PADILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5487
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94524-0487
Mailing Address - Country:US
Mailing Address - Phone:925-672-5700
Mailing Address - Fax:925-672-1374
Practice Address - Street 1:11540 MARSH CREEK RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-9759
Practice Address - Country:US
Practice Address - Phone:925-672-5700
Practice Address - Fax:925-672-1374
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)