Provider Demographics
NPI:1043639966
Name:MADERA WOMENS HEALTH INC
Entity type:Organization
Organization Name:MADERA WOMENS HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DHILLON ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-638-8187
Mailing Address - Street 1:300 E ALMOND AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637
Mailing Address - Country:US
Mailing Address - Phone:559-673-8031
Mailing Address - Fax:559-673-2836
Practice Address - Street 1:300 E ALMOND AVE
Practice Address - Street 2:STE 108
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5653
Practice Address - Country:US
Practice Address - Phone:559-673-8031
Practice Address - Fax:559-673-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A779500Medicaid
CA00A779500Medicaid