| Doctor Name: | MR. JORGE PADRON |
| NPI Number: | 1023444957 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CADC |
| License Number: | 155 |
| Business Practice Address: | 543 3rd St Idaho Falls, ID - 834013909 |
| Business Phone Number: | 2085226925 |
| Business Fax Number: | 2085226934 |
| Mailing Address: | 550 Amy Ln, AMMON |
| State: | ID |
| Postal Code: | 834064542 |
| Phone Number: | 2085894139 |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2013 |
| NPI Last Update Date: | 09/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 155 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |