Provider Demographics
NPI:1710212980
Name:PADILLA, MICHAEL ANDREW (LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:PADILLA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 S CROSS CREEK RD
Mailing Address - Street 2:UNIT K
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5814
Mailing Address - Country:US
Mailing Address - Phone:949-466-9994
Mailing Address - Fax:
Practice Address - Street 1:31762 MISSION TRL
Practice Address - Street 2:STE B
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4545
Practice Address - Country:US
Practice Address - Phone:949-466-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist