Provider Demographics
NPI:1851961767
Name:PADILLA, JOSHUA DANIEL (SUDCC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DANIEL
Last Name:PADILLA
Suffix:
Gender:M
Credentials:SUDCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 JANES RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4721
Mailing Address - Country:US
Mailing Address - Phone:949-202-7750
Mailing Address - Fax:
Practice Address - Street 1:2107 1ST ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0840
Practice Address - Country:US
Practice Address - Phone:707-273-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)