Basic Information
| Provider Information | |||||||||
| NPI: | 1891468542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | ALTAGRACIA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | AMFT # 125138 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9825 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912260825 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15340 DEVONSHIRE ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913452760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238799176 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2021 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 125138 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.