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Individual
DR. ROBERTO MADRID
Active
Individual
DR. ROBERTO MADRID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A56264
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A56264
MEDICAL LICENSE
CA
01
—
GR0084061
PRACTICE LOCATION- ELA
CA
01
—
GR0084062
PRACTICE LOCATION MTB
CA
01
—
GROO84064
PRACTICE LOCATION PAS
CA
Enumeration date
07/25/2006
Last updated
07/09/2007
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