Individual
JAZMN SAMANTHA MATAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 PARK AVE, DEKALB, IL 60115-3104
(912) 996-4514
Mailing address
100 PARK AVE, DEKALB, IL 60115-3104
(912) 996-4514
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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