Basic Information
Provider Information | |||||||||
NPI: | 1548593627 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CADIZ | ||||||||
FirstName: | MADONNA | ||||||||
MiddleName: | PAZ | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW, PPSC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4760 SEPULVEDA BLVD | ||||||||
Address2: |   | ||||||||
City: | CULVER CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 902304820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3103906612 | ||||||||
FaxNumber: | 3103985690 | ||||||||
Practice Location | |||||||||
Address1: | 11133 WASHINGTON BLVD | ||||||||
Address2: |   | ||||||||
City: | CULVER CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 902323918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108952334 | ||||||||
FaxNumber: | 3108952395 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/08/2009 | ||||||||
LastUpdateDate: | 08/21/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW 29389 | CA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.