Provider Demographics
NPI:1306492996
Name:PADILLA, SOPHIA ESPERANZA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ESPERANZA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 PAGE ST APT 301
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2258
Mailing Address - Country:US
Mailing Address - Phone:209-373-0251
Mailing Address - Fax:
Practice Address - Street 1:134 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3810
Practice Address - Country:US
Practice Address - Phone:415-673-0911
Practice Address - Fax:415-749-1032
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124719106H00000X
390200000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor