MEDICARE: MARIAH 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528213444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH MADRIGAL

Provider Business Mailing Address
First Line	:	11227 VALLEY BLVD STE 100
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3299
Country	:	US
Telephone Number	:	626-444-0705
Fax Number	:	626-444-0710

Provider Business Practice Location Address
First Line	:	11227 VALLEY BLVD STE 100
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3299
Country	:	US
Telephone Number	:	626-444-0705
Fax Number	:	626-444-0710

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

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	09/21/2021

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Directions to “ MARIAH MADRIGAL ” Practice Location

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