Provider Demographics
NPI:1154196947
Name:MADRUGA RODRIGUEZ, MARICELY
Entity type:Individual
Prefix:
First Name:MARICELY
Middle Name:
Last Name:MADRUGA RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 RANCHESTER DR APT 901
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2483
Mailing Address - Country:US
Mailing Address - Phone:346-546-4004
Mailing Address - Fax:
Practice Address - Street 1:5909 RANCHESTER DR APT 901
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2483
Practice Address - Country:US
Practice Address - Phone:346-546-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician