Provider Demographics
NPI:1780420984
Name:PADILLA, JOSEPH RAUL JR (APRN)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RAUL
Last Name:PADILLA
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1648
Mailing Address - Country:US
Mailing Address - Phone:604-562-2618
Mailing Address - Fax:860-450-1357
Practice Address - Street 1:140 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1648
Practice Address - Country:US
Practice Address - Phone:860-456-2261
Practice Address - Fax:860-450-1357
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT13940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health