Provider Demographics
NPI:1003993759
Name:MADRUGA, ROSEMARY M (MFT)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:M
Last Name:MADRUGA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2056
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-2056
Mailing Address - Country:US
Mailing Address - Phone:916-491-4629
Mailing Address - Fax:530-622-2793
Practice Address - Street 1:8788 ELK GROVE BLVD # 3-12A
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1766
Practice Address - Country:US
Practice Address - Phone:916-491-4629
Practice Address - Fax:530-622-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38659106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist