Provider Demographics
NPI:1104122118
Name:PADILLA, ABDIN
Entity type:Individual
Prefix:MR
First Name:ABDIN
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0221
Mailing Address - Country:US
Mailing Address - Phone:787-341-5509
Mailing Address - Fax:
Practice Address - Street 1:CARR. 416 KM 5.7 SECTOR LA NUEVA OLA
Practice Address - Street 2:BARRIO LAGUNA
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0221
Practice Address - Country:US
Practice Address - Phone:787-341-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3916103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool