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NPI Code Detail

MEDICARE: CLARA MATTA

MEDICARE: CLARA MATTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1932503505
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARA MATTA
Provider Business Mailing Address
First Line : 5776 STONERIDGE MALL RD STE 340
Second Line :
City : PLEASANTON
State : CA
Zip : 94588-4514
Country : US
Telephone Number : 925-223-8047
Fax Number :
Provider Business Practice Location Address
First Line : 5776 STONERIDGE MALL RD STE 340
Second Line :
City : PLEASANTON
State : CA
Zip : 94588-4514
Country : US
Telephone Number : 925-223-8047
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2014
Last Update Date : 10/10/2014

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Directions to “ CLARA MATTA ” Practice Location

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