Provider Demographics
NPI:1619476207
Name:MADRID, MARGARITA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:MADRID
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17505 N 79TH AVE
Mailing Address - Street 2:STE 213A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8728
Mailing Address - Country:US
Mailing Address - Phone:602-584-5859
Mailing Address - Fax:602-584-5859
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:STE 213A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8728
Practice Address - Country:US
Practice Address - Phone:602-584-5859
Practice Address - Fax:602-584-5859
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10942363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health