Healthcare Provider Details

I. General information

NPI: 1225762693
Provider Name (Legal Business Name): ERICA JANE MADRID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

2241 HARVARD ST STE 300
SACRAMENTO CA
95815-3332
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-2082
  • Fax:
Mailing address:
  • Phone: 916-614-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: