Healthcare Provider Details

I. General information

NPI: 1316875289
Provider Name (Legal Business Name): RICHARD MADES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2562 STATE ST
CARLSBAD CA
92008-1663
US

IV. Provider business mailing address

2874 CORTO ST
OCEANSIDE CA
92054-4519
US

V. Phone/Fax

Practice location:
  • Phone: 833-772-5615
  • Fax:
Mailing address:
  • Phone: 540-903-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberINTERN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: