Provider Demographics
NPI:1417372277
Name:MADRIGAL, MARIBEL
Entity Type:Individual
Prefix:
First Name:MARIBEL
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:PO BOX 1456
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-1456
Mailing Address - Country:US
Mailing Address - Phone:831-461-5902
Mailing Address - Fax:831-688-1718
Practice Address - Street 1:3060 VALENCIA AVE STE 7
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4165
Practice Address - Country:US
Practice Address - Phone:831-460-2550
Practice Address - Fax:831-688-1718
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116479106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist