Individual
MARIO MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10200 NE 132ND ST, KIRKLAND, WA 98034-2831
(425) 821-2000
Mailing address
19435 68TH AVE S STE S101, KENT, WA 98032-2114
(206) 407-4171
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP60886621
WA
363LG0600X
Gerontology Nurse Practitioner
AP60886621
WA
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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