Provider Demographics
NPI:1033003850
Name:PADILLA LOPEZ, AUNDRE
Entity type:Individual
Prefix:
First Name:AUNDRE
Middle Name:
Last Name:PADILLA LOPEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S ALMA SCHOOL RD APT 206
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3018
Mailing Address - Country:US
Mailing Address - Phone:915-525-3774
Mailing Address - Fax:
Practice Address - Street 1:2601 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8221
Practice Address - Country:US
Practice Address - Phone:915-525-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-050149224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant