Provider Demographics
NPI:1447913827
Name:PADULA, NICHOLAS (RD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PADULA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:PADULA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:525 E SEASIDE WAY UNIT 1504
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-8011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 E SEASIDE WAY UNIT 1504
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-8011
Practice Address - Country:US
Practice Address - Phone:818-800-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD8086848OtherDRIVERS LICENSE