Basic Information
| Provider Information | |||||||||
| NPI: | 1801093539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 204 | ||||||||
| Address2: | |||||||||
| City: | TUCUMCARI | ||||||||
| State: | NM | ||||||||
| PostalCode: | 884010204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054614800 | ||||||||
| FaxNumber: | 5054614802 | ||||||||
| Practice Location | |||||||||
| Address1: | 5312 JAGUAR DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875071827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058200262 | ||||||||
| FaxNumber: | 5058209220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | M-06572 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.