Provider Demographics
NPI:1720152515
Name:PADILLA-BURGER, JENNIFER NICOLE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:PADILLA-BURGER
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 1:1236 CHAPALA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3116
Mailing Address - Country:US
Mailing Address - Phone:805-259-8195
Mailing Address - Fax:805-614-9363
Practice Address - Street 1:218 CARMEN LN
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7772
Practice Address - Country:US
Practice Address - Phone:805-259-8195
Practice Address - Fax:805-614-9363
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist