Provider Demographics
NPI:1427714641
Name:NAJERA MADRID, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:NAJERA MADRID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17216 SATICOY ST # 141
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2103
Mailing Address - Country:US
Mailing Address - Phone:818-206-3353
Mailing Address - Fax:
Practice Address - Street 1:13711 VAN NUYS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3638
Practice Address - Country:US
Practice Address - Phone:818-206-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty