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General NPI Number Information
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NPI Number | 1700376548
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Entity Type | Individual
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Provider Name | ELIZABETH MATHEW AGACNP DNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 210 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723-1515
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Country | US
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Telephone | 626-331-7331
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Fax |
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Provider Business Mailing Address
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Address Line | 11883 MOUNT HARVARD CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-7915
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Country | US
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Telephone | 626-347-4465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95009065
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License Number State | CA
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