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NPI Code Detail

MEDICARE: MAX MADRIGAL

MEDICARE:   MAX  MADRIGAL
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1063273878
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAX MADRIGAL
Provider Business Mailing Address
First Line : 225 ALTAIR AVE
Second Line :
City : LOMPOC
State : CA
Zip : 93436-1423
Country : US
Telephone Number : 805-415-4571
Fax Number :
Provider Business Practice Location Address
First Line : 225 ALTAIR AVE
Second Line :
City : LOMPOC
State : CA
Zip : 93436-1423
Country : US
Telephone Number : 805-415-4571
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2024
Last Update Date : 01/18/2024

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Directions to “ MAX MADRIGAL ” Practice Location

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