Healthcare Provider Details

I. General information

NPI: 1053546325
Provider Name (Legal Business Name): MS. ADRIANNE MADRID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 WHITTIER BLVD
LOS ANGELES CA
90022-4222
US

IV. Provider business mailing address

10511 MILLS AVE
WHITTIER CA
90604-2440
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-6855
  • Fax:
Mailing address:
  • Phone: 661-597-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberNA
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: