1174237135 NPI number — ERICK MADRIGAL, MD, MBA INC.

Table of content: (NPI 1174237135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174237135 NPI number — ERICK MADRIGAL, MD, MBA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICK MADRIGAL, MD, MBA INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLINICA AGUA VIVA-WOODLAKE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174237135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W HENDERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93257-1731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-784-5483
Provider Business Mailing Address Fax Number:
559-789-9828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 N PALM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93286-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-564-1100
Provider Business Practice Location Address Fax Number:
559-789-9828
Provider Enumeration Date:
01/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LEYVA
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
559-719-8108

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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