Provider Demographics
NPI:1497898498
Name:MADRIGAL, GUADALUPE (CAODC-A)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:CAODC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23119 COTTONWOOD AVE STE A100
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9661
Mailing Address - Country:US
Mailing Address - Phone:951-413-5130
Mailing Address - Fax:951-413-5230
Practice Address - Street 1:23119 COTTONWOOD AVE STE A100
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9661
Practice Address - Country:US
Practice Address - Phone:951-413-5130
Practice Address - Fax:951-413-5230
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA061359101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)