Provider Demographics
NPI:1841725280
Name:PADILLA, RUBEN SERGIO
Entity type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:SERGIO
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 1:8794 TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-5554
Mailing Address - Country:US
Mailing Address - Phone:818-624-3697
Mailing Address - Fax:
Practice Address - Street 1:8794 TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344
Practice Address - Country:US
Practice Address - Phone:818-624-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst