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General NPI Number Information
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NPI Number | 1659197689
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Entity Type | Organization
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Legal Business Name | ACOSTA-MATEO FAMILY NURSING MEDICAL PRACTICE
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1820 FULLERTON AVE STE 260
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City | CORONA
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State | CA
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Zip | 92881-3101
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Country | US
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Telephone | 361-219-0379
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Fax |
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Provider Business Mailing Address
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Address Line | 13949 BLOSSOM WAY
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City | EASTVALE
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State | CA
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Zip | 92880-6409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRISTINA ACOSTA MATEO
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Credential | NP
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Telephone | 361-219-0379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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