Healthcare Provider Details

I. General information

NPI: 1336916782
Provider Name (Legal Business Name): KATHERINE MATUSHEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79430 HIGHWAY 111 STE 102
LA QUINTA CA
92253-4549
US

IV. Provider business mailing address

79430 HIGHWAY 111 STE 102
LA QUINTA CA
92253-4549
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax:
Mailing address:
  • Phone: 844-827-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12654079-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: