Healthcare Provider Details

I. General information

NPI: 1235967704
Provider Name (Legal Business Name): ARIEL INOCENCIO MADRIGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 SKYLANE BLVD
SANTA ROSA CA
95403-8246
US

IV. Provider business mailing address

814 VINEYARD CREEK DR APT 233
SANTA ROSA CA
95403-9010
US

V. Phone/Fax

Practice location:
  • Phone: 707-524-2600
  • Fax:
Mailing address:
  • Phone: 707-304-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: