Basic Information
| Provider Information | |||||||||
| NPI: | 1548995277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | JUDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30724 BENTON RD | ||||||||
| Address2: | STE C- 302 #415 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022621256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1105 E FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925434512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514392939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2022 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.