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
1	1041C0700X	Clinical Social Worker	76087	CA

General Provider Information

NPI Number	:	1154633766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX MADRIGAL

Provider Business Mailing Address
First Line	:	1141 PEAR TREE LN
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-6484
Country	:	US
Telephone Number	:	707-254-1770
Fax Number	:	707-254-1779

Provider Business Practice Location Address
First Line	:	470 CHADBOURNE RD
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9600
Country	:	US
Telephone Number	:	707-419-8989
Fax Number	:	707-254-1779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	12/03/2025

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