Basic Information
| Provider Information | |||||||||
| NPI: | 1720707789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | TEREASA | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2634 GRANDE VALLEY BLVD APT 4310 | ||||||||
| Address2: | |||||||||
| City: | ORANGE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327637822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3863490093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 537 DELTONA BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327258017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048788683 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 22229955 | FL | Y |
No ID Information.