Provider Demographics
NPI:1982451217
Name:PADILLA AVENDANO, RAUL ALBERTO
Entity type:Individual
Prefix:
First Name:RAUL ALBERTO
Middle Name:
Last Name:PADILLA AVENDANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 W 2ND WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5009
Mailing Address - Country:US
Mailing Address - Phone:858-228-0154
Mailing Address - Fax:
Practice Address - Street 1:9010 SW 137TH AVE STE 239
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1408
Practice Address - Country:US
Practice Address - Phone:786-817-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24-337561106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician