Healthcare Provider Details

I. General information

NPI: 1588530802
Provider Name (Legal Business Name): DANIELLE MATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD
TEMECULA CA
92591-4687
US

IV. Provider business mailing address

41125 WADE LN
HEMET CA
92544-9043
US

V. Phone/Fax

Practice location:
  • Phone: 951-466-3196
  • Fax:
Mailing address:
  • Phone: 858-264-5858
  • Fax: 858-264-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: