Provider Demographics
NPI:1740017987
Name:PADILLA, DAYLENE NICOLE (PSS)
Entity type:Individual
Prefix:
First Name:DAYLENE
Middle Name:NICOLE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 DELTA WATERS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5852
Mailing Address - Country:US
Mailing Address - Phone:541-772-4648
Mailing Address - Fax:
Practice Address - Street 1:1916 HOMEVIEW DR APT 8
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3388
Practice Address - Country:US
Practice Address - Phone:541-951-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112156175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist