Most Relevant Information
Provider Data
| NPI Number: | 1003642570 |
| Provider Name: | JACQUELINE MATEO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/11/2024 |
| Last Updated: | 09/11/2024 |
Provider Practice Location
12099 W WASHINGTON BLVD STE 200
LOS ANGELES
CA
900662622
Practice Location Phone/Fax
| Phone: | 3107511171 |
| Fax: |
Provider Mailing Location
12099 W WASHINGTON BLVD STE 200
LOS ANGELES
CA
900662622
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |