Provider Demographics
NPI:1558013748
Name:MADRIGAL, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MADRIGAL
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 1:11217 MCGIRK AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1649
Mailing Address - Country:US
Mailing Address - Phone:626-602-4800
Mailing Address - Fax:
Practice Address - Street 1:11217 MCGIRK AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1649
Practice Address - Country:US
Practice Address - Phone:626-602-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician