Provider Demographics
NPI:1083255475
Name:PADILLA, NATTASHA I
Entity type:Individual
Prefix:
First Name:NATTASHA
Middle Name:I
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NATTASHA
Other - Middle Name:I
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:HC 44 BOX 12540
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9702
Mailing Address - Country:US
Mailing Address - Phone:787-641-0773
Mailing Address - Fax:
Practice Address - Street 1:URB. VISTALAGO
Practice Address - Street 2:56 CALLE LAGO CARRAIZO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-436-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146881041C0700X
PR8002103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical