Provider Demographics
NPI:1396562955
Name:MADRID, MARIA SUZANNE (CHW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:SUZANNE
Last Name:MADRID
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6927
Mailing Address - Country:US
Mailing Address - Phone:972-825-3713
Mailing Address - Fax:
Practice Address - Street 1:123 CACTUS RD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-6927
Practice Address - Country:US
Practice Address - Phone:972-825-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10212172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker