Provider Demographics
NPI:1437607223
Name:MADRID, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
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 1:1401 ALMOND AVENUE
Mailing Address - Street 2:20
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550
Mailing Address - Country:US
Mailing Address - Phone:510-688-6238
Mailing Address - Fax:
Practice Address - Street 1:1401 ALMOND AVENUE
Practice Address - Street 2:20
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550
Practice Address - Country:US
Practice Address - Phone:510-688-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker