Provider Demographics
NPI:1609124692
Name:ERICK MADRIGAL, MD, MBA, INC.
Entity Type:Organization
Organization Name:ERICK MADRIGAL, MD, MBA, INC.
Other - Org Name:LIVING WATER COMMUNITY HEALTH & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-719-8108
Mailing Address - Street 1:222 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1731
Mailing Address - Country:US
Mailing Address - Phone:559-784-5483
Mailing Address - Fax:559-784-5433
Practice Address - Street 1:222 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1731
Practice Address - Country:US
Practice Address - Phone:559-784-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHC181AMedicare PIN