Healthcare Provider Details

I. General information

NPI: 1962807727
Provider Name (Legal Business Name): CRISTINA MADORY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S GRAND AVE STE C
SANTA ANA CA
92705-4434
US

IV. Provider business mailing address

1300 S GRAND AVE STE C
SANTA ANA CA
92705-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-567-7508
  • Fax: 714-567-7633
Mailing address:
  • Phone: 714-567-7508
  • Fax: 714-567-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number85204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: