Healthcare Provider Details

I. General information

NPI: 1013518885
Provider Name (Legal Business Name): CATHY MADRIGAL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 LA MESA BLVD STE 25
LA MESA CA
91942-0335
US

IV. Provider business mailing address

12662 RAGWEED ST
SAN DIEGO CA
92129-3623
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax: 619-782-0710
Mailing address:
  • Phone: 805-720-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-143053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: