Provider Demographics
NPI:1619347267
Name:MADRIGAL, MAYRA (BILLER)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:BILLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 ALMADEN RD APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-3625
Mailing Address - Country:US
Mailing Address - Phone:408-685-5553
Mailing Address - Fax:
Practice Address - Street 1:5727 ALMADEN RD APT 1
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-3625
Practice Address - Country:US
Practice Address - Phone:408-685-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator