Healthcare Provider Details

I. General information

NPI: 1053955740
Provider Name (Legal Business Name): MR. MATHEW ADRIAN MADRIGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W HENDERSON AVE STE 2
PORTERVILLE CA
93257-1490
US

IV. Provider business mailing address

1055 W HENDERSON AVE STE 2
PORTERVILLE CA
93257-1490
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-1200
  • Fax: 559-749-9772
Mailing address:
  • Phone: 559-788-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: