Basic Information
| Provider Information | |||||||||
| NPI: | 1093362030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | LARRY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | LICENSED VOCATIONAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 N MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920203906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195798373 | ||||||||
| FaxNumber: | 6195798155 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 N MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920203906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195798373 | ||||||||
| FaxNumber: | 6195798155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2019 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN247240 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.