Provider Demographics
NPI:1548652597
Name:MADRIAGA, EMELITA
Entity type:Individual
Prefix:
First Name:EMELITA
Middle Name:
Last Name:MADRIAGA
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 1:8348 DANDELION DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4559
Mailing Address - Country:US
Mailing Address - Phone:916-996-8457
Mailing Address - Fax:
Practice Address - Street 1:7622 COUNTRY PARK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4905
Practice Address - Country:US
Practice Address - Phone:916-682-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3470018863747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant