1811132004 NPI number — JESSICA GONZALEZ PADILLA LPC

Table of content: JESSICA GONZALEZ PADILLA LPC (NPI 1811132004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811132004 NPI number — JESSICA GONZALEZ PADILLA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADILLA
Provider First Name:
JESSICA
Provider Middle Name:
GONZALEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811132004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3103 WEST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78213-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-340-8077
Provider Business Mailing Address Fax Number:
210-340-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 OLD SAN ANTONIO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-816-2425
Provider Business Practice Location Address Fax Number:
830-249-8714
Provider Enumeration Date:
12/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  63035 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)