MEDICARE: MADISON HO

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	101YP2500X	Professional Counselor	19852	CA

General Provider Information

NPI Number	:	1740136779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON HO

Provider Business Mailing Address
First Line	:	1653 7TH ST
Second Line	:	PO BOX 1301
City	:	SANTA MONICA
State	:	CA
Zip	:	90401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27118 SILVER SPUR RD
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-2300
Country	:	US
Telephone Number	:	323-744-1217
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ MADISON HO ” Practice Location

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