Healthcare Provider Details

I. General information

NPI: 1770085813
Provider Name (Legal Business Name): YVETTE MADKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 44TH ST RM 104
SACRAMENTO CA
95820-3909
US

IV. Provider business mailing address

4150 ARDWELL WAY
SACRAMENTO CA
95823-5045
US

V. Phone/Fax

Practice location:
  • Phone: 916-741-2725
  • Fax:
Mailing address:
  • Phone: 916-519-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: