Provider Demographics
NPI:1508527862
Name:MADRIGAL SALABARRIA, YADIREY
Entity Type:Individual
Prefix:
First Name:YADIREY
Middle Name:
Last Name:MADRIGAL SALABARRIA
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 1:4062 VICLIFF RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8507
Mailing Address - Country:US
Mailing Address - Phone:561-929-0692
Mailing Address - Fax:
Practice Address - Street 1:4062 VICLIFF RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8507
Practice Address - Country:US
Practice Address - Phone:561-929-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-198021106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty