Healthcare Provider Details

I. General information

NPI: 1144792557
Provider Name (Legal Business Name): MADISON MINCHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2018
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 S EL CAMINO REAL STE 102
OCEANSIDE CA
92054-6209
US

IV. Provider business mailing address

1341 N ESCONDIDO BLVD
ESCONDIDO CA
92026-2507
US

V. Phone/Fax

Practice location:
  • Phone: 760-290-8170
  • Fax:
Mailing address:
  • Phone: 760-747-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: