Provider Demographics
NPI:1124454137
Name:MADRIGAL, PATRICIA (MA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19700 S VERMONT AVE
Mailing Address - Street 2:SUITE 200 & 250
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1100
Mailing Address - Country:US
Mailing Address - Phone:213-252-5800
Mailing Address - Fax:
Practice Address - Street 1:19700 S VERMONT AVE
Practice Address - Street 2:SUITE 200 & 250
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1100
Practice Address - Country:US
Practice Address - Phone:213-252-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 171M00000X
CA93149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator