Healthcare Provider Details

I. General information

NPI: 1982587671
Provider Name (Legal Business Name): ESTEPHANIA MADRIGAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 & 386 COALINGA PLAZA
COALINGA CA
93210
US

IV. Provider business mailing address

380 & 386 COALINGA PLAZA
COALINGA CA
93210
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax:
Mailing address:
  • Phone: 855-343-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN735582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: