Provider Demographics
NPI:1952928632
Name:PADILLA, LESLIE PRISCILLA
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:PRISCILLA
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 1:1787 HARMONY WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1763
Mailing Address - Country:US
Mailing Address - Phone:925-325-0464
Mailing Address - Fax:
Practice Address - Street 1:3075 CITRUS CIR # 249
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2666
Practice Address - Country:US
Practice Address - Phone:925-256-1100
Practice Address - Fax:925-256-1100
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB606969106S00000X
106S00000X
CARBT-20-135055106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician