Provider Demographics
NPI:1437584547
Name:MADERO, RICHARD PIEDRA
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PIEDRA
Last Name:MADERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28235 CASCADE RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3774
Mailing Address - Country:US
Mailing Address - Phone:818-378-0594
Mailing Address - Fax:661-775-9836
Practice Address - Street 1:210 S DE LACEY AVE
Practice Address - Street 2:HATHAWAY-SYCAMORES
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2048
Practice Address - Country:US
Practice Address - Phone:626-395-7100
Practice Address - Fax:626-685-2126
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner