Provider Demographics
NPI:1184115438
Name:ATTALLA, MADONNA MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MADONNA
Middle Name:MICHAEL
Last Name:ATTALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 W REESE CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-0609
Mailing Address - Country:US
Mailing Address - Phone:559-302-8000
Mailing Address - Fax:
Practice Address - Street 1:252 CA-65
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247
Practice Address - Country:US
Practice Address - Phone:559-302-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA175856207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine