Basic Information
| Provider Information | |||||||||
| NPI: | 1568903102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADRIGAL | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8110 GARDENDALE ST APT A | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907232464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623553549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 315 CAMINO DEL REMEDIO | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056815244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2017 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95086347 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.