Healthcare Provider Details

I. General information

NPI: 1073932133
Provider Name (Legal Business Name): YARA MATTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25405 HANCOCK AVE STE 202
MURRIETA CA
92562-5978
US

IV. Provider business mailing address

225 E 2ND AVE
ESCONDIDO CA
92025-4249
US

V. Phone/Fax

Practice location:
  • Phone: 760-291-6700
  • Fax: 951-405-4571
Mailing address:
  • Phone: 760-291-6700
  • Fax: 951-405-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA137962
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA137962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: