Individual
MARIE PADILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907-1510
(401) 456-3649
Mailing address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
ELT0120
RI
247200000X
Other Technician
ELT0120
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ELT0120
LICENSE NUMBER
RI
Enumeration date
12/08/2006
Last updated
08/26/2008
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