Basic Information
| Provider Information | |||||||||
| NPI: | 1538881511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA-HARROLD | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077187963 | ||||||||
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| Practice Location | |||||||||
| Address1: | 470 CHADBOURNE RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072248266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2022 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.