Provider Demographics
NPI:1629733738
Name:MADRIGAL, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MADRIGAL
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 1:28892 CANYON RIM DR
Mailing Address - Street 2:
Mailing Address - City:PORTOLA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1054
Mailing Address - Country:US
Mailing Address - Phone:949-444-9062
Mailing Address - Fax:
Practice Address - Street 1:28892 CANYON RIM DR
Practice Address - Street 2:
Practice Address - City:PORTOLA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92679-1054
Practice Address - Country:US
Practice Address - Phone:949-444-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program