Basic Information
| Provider Information | |||||||||
| NPI: | 1285064659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA DALMAU | ||||||||
| FirstName: | YANIZ | ||||||||
| MiddleName: | CRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | M/S CAC PO BOX 5371 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069878080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4909 25TH AVE NE STE 120 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981054107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069878080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2013 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103T00000X | PY60674497 | WA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 1825 | 05 | VA | MEDICAID |