Healthcare Provider Details

I. General information

NPI: 1801311980
Provider Name (Legal Business Name): STEPHANIE MADRID A.A. HARTNELL COLLEG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEACH DR
SALINAS CA
93901-3710
US

IV. Provider business mailing address

333 PARK ST
SALINAS CA
93901-2032
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: