Provider Demographics
NPI:1285896290
Name:PADAOAN, JOSELITO R (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSELITO
Middle Name:R
Last Name:PADAOAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:PADAOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1251 N MILLER RD
Mailing Address - Street 2:APT #240
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3613
Mailing Address - Country:US
Mailing Address - Phone:832-875-7651
Mailing Address - Fax:
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-882-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8085A282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital