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NPI Code Detail

MEDICARE: JOSEPH MADRID LCSW

MEDICARE:   JOSEPH  MADRID  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker94030CA

General Provider Information

NPI Number : 1003438433
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH MADRID LCSW
Provider Business Mailing Address
First Line : 252 16TH PL APT C
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-9410
Country : US
Telephone Number : 949-566-5222
Fax Number :
Provider Business Practice Location Address
First Line : 252 16TH PL APT C
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-9410
Country : US
Telephone Number : 949-566-5222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2020
Last Update Date : 05/07/2020

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Directions to “ JOSEPH MADRID LCSW” Practice Location

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