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Individual

DR. CECELIA THERESA MADRID

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2701 W ALAMEDA AVE STE 500, BURBANK, CA 91505-4410
(818) 567-6550
(818) 558-4379
Mailing address
2701 W ALAMEDA AVE STE 500, BURBANK, CA 91505-4410
(818) 567-6550
(818) 558-4379

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G48480
CA
207RG0100X
Gastroenterology Physician
G48480
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
G48480
CA
2084P0800X
Psychiatry Physician
G48480
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G484800
BLUE SHIELD
CA
05
00G484800
CA
01
95 4245140
TAX IDENTIFICATION NUMBER
01
954245140
BLUE CROSS
CA
Enumeration date
01/18/2007
Last updated
02/20/2019
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