Provider Demographics
NPI:1376800813
Name:MADRID, JACQUELINE ALEXY
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALEXY
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 1:1187 EAST SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963
Mailing Address - Country:US
Mailing Address - Phone:530-865-1622
Mailing Address - Fax:530-865-7073
Practice Address - Street 1:612 4TH STREET
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963
Practice Address - Country:US
Practice Address - Phone:530-865-1622
Practice Address - Fax:530-865-7073
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator