Provider Demographics
NPI:1952816969
Name:PADILLA GALIS MENENDEZ, ISIS E
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:E
Last Name:PADILLA GALIS MENENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5756
Mailing Address - Country:US
Mailing Address - Phone:786-357-2675
Mailing Address - Fax:
Practice Address - Street 1:4600 SW 97TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5756
Practice Address - Country:US
Practice Address - Phone:786-357-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-48140103K00000X
FL106E00000X, 106S00000X
FL1-248140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician