Provider Demographics
NPI:1831669019
Name:PADILLA, CANDICE RAE (IBCLC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:RAE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:RAE
Other - Last Name:GUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:172A COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-7834
Mailing Address - Country:US
Mailing Address - Phone:505-916-4020
Mailing Address - Fax:
Practice Address - Street 1:172A COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-7834
Practice Address - Country:US
Practice Address - Phone:505-916-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor