Provider Demographics
NPI:1700577202
Name:PADILLA, KATRINA ANN
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:PADILLA
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:RIO ARRIBA COUNTY/ HHS ATTN: KATRINA PADILLA
Mailing Address - Street 2:1122 INDUSTRIAL PARK RD.
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-1279
Mailing Address - Country:US
Mailing Address - Phone:505-310-8937
Mailing Address - Fax:
Practice Address - Street 1:RIO ARRIBA COUNTY/ HHS ATTN: KATRINA PADILLA
Practice Address - Street 2:1122 INDUSTRIAL PARK RD.
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-1279
Practice Address - Country:US
Practice Address - Phone:505-310-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1389OtherCPSW