Healthcare Provider Details

I. General information

NPI: 1730010166
Provider Name (Legal Business Name): MADISON COMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E ROWLAND ST
COVINA CA
91723-3147
US

IV. Provider business mailing address

223 E ROWLAND ST
COVINA CA
91723-3147
US

V. Phone/Fax

Practice location:
  • Phone: 626-332-3145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1438190426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: