Healthcare Provider Details

I. General information

NPI: 1194393306
Provider Name (Legal Business Name): ANGELICA MADRIGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COLUMBIA AVE STE 300
LOS ANGELES CA
90017-1209
US

IV. Provider business mailing address

PO BOX 421
MONTEBELLO CA
90640-0421
US

V. Phone/Fax

Practice location:
  • Phone: 213-553-9121
  • Fax: 213-201-3395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102632
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131854
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: