MEDICARE: M EILEEN MADRID M.D.

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	174400000X	Specialist	81-79	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215997358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M EILEEN MADRID M.D.

Provider Business Mailing Address
First Line	:	419 MANZANARES ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3882
Country	:	US
Telephone Number	:	505-425-6773
Fax Number	:	505-426-9238

Provider Business Practice Location Address
First Line	:	419 MANZANARES ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3882
Country	:	US
Telephone Number	:	505-425-6773
Fax Number	:	505-426-9238

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/08/2010

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