Healthcare Provider Details

I. General information

NPI: 1972465060
Provider Name (Legal Business Name): CRISTIAN MATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23504 LYONS AVE STE 401B
NEWHALL CA
91321-5777
US

IV. Provider business mailing address

23504 LYONS AVE STE 401B
NEWHALL CA
91321-5777
US

V. Phone/Fax

Practice location:
  • Phone: 661-977-4747
  • Fax: 661-999-3313
Mailing address:
  • Phone: 661-977-4747
  • Fax: 661-999-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC19787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: