Individual
IVAN ALEXANDER PADILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
2255 W CENTRE AVE, PORTAGE, MI 49024-4819
(269) 257-9060
Mailing address
2255 W CENTRE AVE, PORTAGE, MI 49024-4819
(269) 257-9060
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
385HR2050X
Respite Care Camp
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/16/2025
Last updated
05/10/2026
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