Provider Demographics
NPI:1043667298
Name:MADRIGAL, RENDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENDA
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RENDA
Other - Middle Name:
Other - Last Name:DIONNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:31805 TEMECULA PKWY # 552
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8203
Mailing Address - Country:US
Mailing Address - Phone:909-262-8325
Mailing Address - Fax:
Practice Address - Street 1:31805 TEMECULA PKWY # 552
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8203
Practice Address - Country:US
Practice Address - Phone:909-262-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14246103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist