Healthcare Provider Details

I. General information

NPI: 1245163187
Provider Name (Legal Business Name): NOAH MATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12277 STUVELING ST
OAK HILLS CA
92344-9664
US

IV. Provider business mailing address

12277 STUVELING ST
OAK HILLS CA
92344-9664
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-5506
  • Fax:
Mailing address:
  • Phone: 760-995-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3859677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: