Basic Information
| Provider Information | |||||||||
| NPI: | 1952928632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | PRISCILLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1787 HARMONY WAY | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945651763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253250464 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3075 CITRUS CIR # 249 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252561100 | ||||||||
| FaxNumber: | 9252561100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | BACB606969 | CA | N | 106S00000X | N | 106S00000X | RBT-20-135055 | CA | Y |
No ID Information.