Healthcare Provider Details

I. General information

NPI: 1790603165
Provider Name (Legal Business Name): KIMBERLY PEREZ MADRIGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 ROSIN CT STE 130
SACRAMENTO CA
95834-1699
US

IV. Provider business mailing address

2732 GROVE AVE UNIT C95815
SACRAMENTO CA
95815-1650
US

V. Phone/Fax

Practice location:
  • Phone: 916-374-0800
  • Fax:
Mailing address:
  • Phone: 916-617-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: