Provider Demographics
NPI:1497181200
Name:MADRIGAL, TRACEY RUBY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:RUBY
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 1:2580 VICTOR AVE STE C
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1455
Mailing Address - Country:US
Mailing Address - Phone:530-328-8127
Mailing Address - Fax:
Practice Address - Street 1:2580 VICTOR AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1455
Practice Address - Country:US
Practice Address - Phone:530-328-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator