Provider Demographics
NPI:1750823167
Name:BADILLO, CAROLYN WARD (ATC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:WARD
Last Name:BADILLO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 FULTON ST
Mailing Address - Street 2:ATTN. ATHLETIC TRAINING
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2130 FULTON ST
Practice Address - Street 2:ATTN. ATHLETIC TRAINING
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1080
Practice Address - Country:US
Practice Address - Phone:415-422-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer