Provider Demographics
NPI:1447093745
Name:MADARIAGA, MATHEW
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:MADARIAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 N PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1862
Mailing Address - Country:US
Mailing Address - Phone:352-012-7724
Mailing Address - Fax:
Practice Address - Street 1:1032 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1862
Practice Address - Country:US
Practice Address - Phone:435-201-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11301150-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse