Provider Demographics
NPI:1639836208
Name:JORDAN-MADRIGAL, TANYX (ASW)
Entity Type:Individual
Prefix:
First Name:TANYX
Middle Name:
Last Name:JORDAN-MADRIGAL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:TANYX
Other - Middle Name:
Other - Last Name:MADRIGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:PO BOX 45984
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-0984
Mailing Address - Country:US
Mailing Address - Phone:424-209-7851
Mailing Address - Fax:
Practice Address - Street 1:5601 W SLAUSON AVE STE 220
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6648
Practice Address - Country:US
Practice Address - Phone:424-209-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA993961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical