Provider Demographics
NPI:1134637952
Name:GAMEZ, MADELAINE ANTONIA (FNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:ANTONIA
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S CENTRAL AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4647
Mailing Address - Country:US
Mailing Address - Phone:818-500-8739
Mailing Address - Fax:818-500-0957
Practice Address - Street 1:710 S CENTRAL AVE STE 330
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4647
Practice Address - Country:US
Practice Address - Phone:818-500-8739
Practice Address - Fax:818-500-0957
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily