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General NPI Number Information
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NPI Number | 1366802902
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Entity Type | Individual
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Provider Name | DESIREE E MADRIGAL
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Gender | Female
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 5101 MARKET ST STE 2100
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City | SAN DIEGO
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State | CA
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Zip | 92114-2224
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Country | US
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Telephone | 619-508-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 MARKET ST. SUITE 2100 ATTENTION: ECC
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City | SAN DIEGO
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State | CA
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Zip | 92114
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Country | US
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Telephone | 619-850-7964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW116486
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License Number State | CA
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