Provider Demographics
NPI:1316355860
Name:MADRIGAL, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:MADRIGAL
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 1:7620 N EL DORADO ST
Mailing Address - Street 2:43
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2146
Mailing Address - Country:US
Mailing Address - Phone:209-808-4051
Mailing Address - Fax:
Practice Address - Street 1:7620 N EL DORADO ST
Practice Address - Street 2:43
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2146
Practice Address - Country:US
Practice Address - Phone:209-808-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)