MEDICARE: ELIZABETH MATHEWS LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	230830	CA

General Provider Information

NPI Number	:	1588174890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MATHEWS LVN

Provider Business Mailing Address
First Line	:	10628 MORNING RIDGE DR
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-4205
Country	:	US
Telephone Number	:	951-385-7072
Fax Number	:

Provider Business Practice Location Address
First Line	:	10628 MORNING RIDGE DR
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-4205
Country	:	US
Telephone Number	:	951-385-7072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	07/21/2022

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