Provider Demographics
NPI:1881233955
Name:PADILLA, MARYJANE DOMENIQUE
Entity type:Individual
Prefix:
First Name:MARYJANE
Middle Name:DOMENIQUE
Last Name:PADILLA
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 1:44107 KIRKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3656
Mailing Address - Country:US
Mailing Address - Phone:818-331-8503
Mailing Address - Fax:
Practice Address - Street 1:1331 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2942
Practice Address - Country:US
Practice Address - Phone:661-940-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator