Provider Demographics
NPI:1184093007
Name:PADILLA, CARLOS ANIBAL JR
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANIBAL
Last Name:PADILLA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1103
Mailing Address - Country:US
Mailing Address - Phone:424-242-9374
Mailing Address - Fax:866-929-7421
Practice Address - Street 1:337 W 131ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-1103
Practice Address - Country:US
Practice Address - Phone:424-242-9374
Practice Address - Fax:866-929-7421
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver