Provider Demographics
NPI:1891486411
Name:PADILLA, MIRANDA (CLC, CD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:CLC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W 120TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6366
Mailing Address - Country:US
Mailing Address - Phone:646-683-6463
Mailing Address - Fax:
Practice Address - Street 1:1850 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1714
Practice Address - Country:US
Practice Address - Phone:646-598-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula