Provider Demographics
NPI:1336430206
Name:MADRID-KERR, EVANGELINA ADRIA (CADCII, MPSS)
Entity type:Individual
Prefix:MS
First Name:EVANGELINA
Middle Name:ADRIA
Last Name:MADRID-KERR
Suffix:
Gender:
Credentials:CADCII, MPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14238 SARANAC LN
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1435
Mailing Address - Country:US
Mailing Address - Phone:661-607-8664
Mailing Address - Fax:
Practice Address - Street 1:14238 SARANAC LN
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1435
Practice Address - Country:US
Practice Address - Phone:661-607-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA09940315172V00000X
CAMPSS-SGMWUK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker