Healthcare Provider Details

I. General information

NPI: 1114637873
Provider Name (Legal Business Name): MADERA COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SUNRISE AVE
MADERA CA
93638-4926
US

IV. Provider business mailing address

1604 SUNRISE AVE
MADERA CA
93638-4926
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-7893
  • Fax:
Mailing address:
  • Phone: 559-675-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEAN KIRKPATRICK
Title or Position: DEPUTY PH DIRECTOR - OPERATIONS
Credential:
Phone: 559-675-7893