Healthcare Provider Details

I. General information

NPI: 1942440334
Provider Name (Legal Business Name): TREANNA LYNNE MATHER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S MAIN ST 200
ORANGE CA
92868-3852
US

IV. Provider business mailing address

280 S MAIN ST 200
ORANGE CA
92868-3852
US

V. Phone/Fax

Practice location:
  • Phone: 714-634-4567
  • Fax: 714-634-4569
Mailing address:
  • Phone: 714-634-4567
  • Fax: 714-634-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA20026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: