Healthcare Provider Details

I. General information

NPI: 1427716273
Provider Name (Legal Business Name): MCCALL ADELE MADRIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date: 12/01/2021
Reactivation Date: 12/28/2021

III. Provider practice location address

900 FULTON AVE STE 205
SACRAMENTO CA
95825
US

IV. Provider business mailing address

900 FULTON AVE STE 205
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-484-3570
  • Fax:
Mailing address:
  • Phone: 916-484-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: