Provider Demographics
NPI:1003695297
Name:MADRUGA, CAMILA
Entity Type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:MADRUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7501
Mailing Address - Country:US
Mailing Address - Phone:561-797-5314
Mailing Address - Fax:
Practice Address - Street 1:4281 FOREST LN
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7501
Practice Address - Country:US
Practice Address - Phone:561-797-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician