Provider Demographics
NPI:1356181432
Name:LUNA MADRIGAL, GISELLE
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:LUNA 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 1:1817 S TAGGART ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3446
Mailing Address - Country:US
Mailing Address - Phone:208-370-8495
Mailing Address - Fax:
Practice Address - Street 1:414 WEST USTICK RD. #100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-576-6464
Practice Address - Fax:208-392-1378
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID45193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker