Provider Demographics
NPI:1558179846
Name:MADRID, MELISSA MARIA
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARIA
Last Name:MADRID
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4962
Mailing Address - Country:US
Mailing Address - Phone:559-625-8890
Mailing Address - Fax:559-733-5053
Practice Address - Street 1:1646 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4962
Practice Address - Country:US
Practice Address - Phone:559-625-8890
Practice Address - Fax:559-733-5053
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1558179846172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty