Provider Demographics
NPI:1194594689
Name:PADILLA GARZA, ELENA (RD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:PADILLA GARZA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LEIGHTON ST APT 415
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-3008
Mailing Address - Country:US
Mailing Address - Phone:617-610-0172
Mailing Address - Fax:
Practice Address - Street 1:2 LEIGHTON ST APT 415
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-3008
Practice Address - Country:US
Practice Address - Phone:617-610-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALDN5519OtherOFFICE OF HEALTH AND HUMAN SERVICES