Provider Demographics
NPI:1982975967
Name:PADILLA, MELODY BETH
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:BETH
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:BETH
Other - Last Name:LIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 APPLE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4443
Mailing Address - Country:US
Mailing Address - Phone:760-439-4577
Mailing Address - Fax:
Practice Address - Street 1:1919 APPLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4443
Practice Address - Country:US
Practice Address - Phone:760-439-4577
Practice Address - Fax:760-439-2301
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor