Basic Information
| Provider Information | |||||||||
| NPI: | 1336363332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADRIGAL | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 ALAMEDA DE LAS PULGAS STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505733542 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 ALAMEDA DE LAS PULGAS STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505733542 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF43117 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT51757 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.