Healthcare Provider Details

I. General information

NPI: 1568940658
Provider Name (Legal Business Name): MARIA DEL CARMEN MADRIGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BROOKWOOD AVE STE A
SANTA ROSA CA
95404-5259
US

IV. Provider business mailing address

101 BROOKWOOD AVE STE A
SANTA ROSA CA
95404-5259
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-6043
  • Fax: 707-575-1060
Mailing address:
  • Phone: 707-575-6043
  • Fax: 707-575-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: