Healthcare Provider Details

I. General information

NPI: 1831850619
Provider Name (Legal Business Name): MATTHEW MADRID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

IV. Provider business mailing address

PO BOX 391248
MOUNTAIN VIEW CA
94039-1248
US

V. Phone/Fax

Practice location:
  • Phone: 650-244-1444
  • Fax:
Mailing address:
  • Phone: 650-918-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: