Provider Demographics
NPI:1871613471
Name:MADRUGA, CHRISTINE (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MADRUGA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 ST MICHAELS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1758
Mailing Address - Country:US
Mailing Address - Phone:925-550-9690
Mailing Address - Fax:
Practice Address - Street 1:613 1ST ST
Practice Address - Street 2:STE 213
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1362
Practice Address - Country:US
Practice Address - Phone:925-608-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical