Basic Information
| Provider Information | |||||||||
| NPI: | 1649360488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10470 OLD PLACERVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 MASON ST | ||||||||
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| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956884646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074545800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/24/2015 | ||||||||
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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 | 225X00000X | OT1528 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | OT1528 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 1770675639 | 01 | CA | PHYSICAL EDGE | OTHER | CT0015280 | 05 | CA | MEDICAID | 1689606469 | 01 | CA | PHYSICAL EDGE | OTHER |