Individual
MARIO MATA
Active
Individual
MARIO MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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
Update your record
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