Provider Demographics
NPI:1770335192
Name:PADILLA, ALFONSO JOSHUA
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:JOSHUA
Last Name:PADILLA
Suffix:
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 1:16912 CUMBERLAND CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4808
Mailing Address - Country:US
Mailing Address - Phone:562-396-8831
Mailing Address - Fax:
Practice Address - Street 1:16912 CUMBERLAND CIR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4808
Practice Address - Country:US
Practice Address - Phone:562-396-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician