Provider Demographics
NPI:1811449200
Name:MADRIGAL-BATES, AMY R
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:R
Last Name:MADRIGAL-BATES
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 1:702 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914
Mailing Address - Country:US
Mailing Address - Phone:541-889-9167
Mailing Address - Fax:541-889-7873
Practice Address - Street 1:17 SW FRAZER AVE STE 282
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-0048
Practice Address - Country:US
Practice Address - Phone:541-278-6330
Practice Address - Fax:541-278-5419
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator