Provider Demographics
NPI:1023297447
Name:PADILLA, ELIGIO ROBERTO (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIGIO
Middle Name:ROBERTO
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 TIERRA DEL RIO NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3259
Mailing Address - Country:US
Mailing Address - Phone:505-345-1879
Mailing Address - Fax:
Practice Address - Street 1:1776 MONTANO RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS DE ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3245
Practice Address - Country:US
Practice Address - Phone:505-344-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical