Provider Demographics
NPI:1295009603
Name:MADRID, CELINA MARIE
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:MARIE
Last Name:MADRID
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 1:3100 PERRY PL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-1000
Mailing Address - Country:US
Mailing Address - Phone:661-706-9507
Mailing Address - Fax:
Practice Address - Street 1:2501 W SHAW AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3307
Practice Address - Country:US
Practice Address - Phone:559-221-1680
Practice Address - Fax:559-221-4336
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health