Provider Demographics
NPI:1609511575
Name:MADRIZ FAJARDO, SENY
Entity Type:Individual
Prefix:
First Name:SENY
Middle Name:
Last Name:MADRIZ FAJARDO
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 1:16817 MYERS LN
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:CA
Mailing Address - Zip Code:95315-9259
Mailing Address - Country:US
Mailing Address - Phone:209-648-5515
Mailing Address - Fax:
Practice Address - Street 1:908 SIERRA DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-3254
Practice Address - Country:US
Practice Address - Phone:209-492-9785
Practice Address - Fax:209-492-9174
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional