Provider Demographics
NPI:1427675339
Name:PADEN, AHMAD (ATC)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:PADEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 CANOGA AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6653
Mailing Address - Country:US
Mailing Address - Phone:818-281-2747
Mailing Address - Fax:
Practice Address - Street 1:4165 E THOUSAND OAKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3837
Practice Address - Country:US
Practice Address - Phone:805-371-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000050082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer