Provider Demographics
NPI:1245456524
Name:PADILLA, VICTOR P (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:P
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 1:717 CANDELARIA RD NW APT F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2470
Mailing Address - Country:US
Mailing Address - Phone:505-321-0177
Mailing Address - Fax:
Practice Address - Street 1:717 CANDELARIA RD NW APT F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2470
Practice Address - Country:US
Practice Address - Phone:505-321-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM619103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N8527Medicaid