Provider Demographics
NPI:1679891725
Name:PADILLA, RAFAEL (PSYD, LMFT)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 THE ALAMEDA
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1143
Mailing Address - Country:US
Mailing Address - Phone:408-710-5484
Mailing Address - Fax:
Practice Address - Street 1:2136 THE ALAMEDA
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1143
Practice Address - Country:US
Practice Address - Phone:408-710-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist