Provider Demographics
NPI:1891217733
Name:PADILLA, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LND
Mailing Address - Street 1:54 MONTE REAL
Mailing Address - Street 2:VILLA DEL MONTE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3575
Mailing Address - Country:US
Mailing Address - Phone:787-213-2801
Mailing Address - Fax:
Practice Address - Street 1:54 MONTE REAL
Practice Address - Street 2:VILLA DEL MONTE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3575
Practice Address - Country:US
Practice Address - Phone:787-213-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR954248136A00000X
PR1561133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered