Provider Demographics
NPI:1285273342
Name:PADILLA, LISA CATHERINE
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:CATHERINE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CATHERINE
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3139
Mailing Address - Country:US
Mailing Address - Phone:619-691-8164
Mailing Address - Fax:619-426-2359
Practice Address - Street 1:1180 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3139
Practice Address - Country:US
Practice Address - Phone:619-691-8164
Practice Address - Fax:619-426-2359
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)