Individual
MR. FERNANDO U MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
10200 MAIN ST, LAMONT, CA 93241-1700
(661) 845-1788
(661) 845-1791
Mailing address
10200 MAIN ST, LAMONT, CA 93241-1700
(661) 845-1788
(661) 845-1791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12281
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA12281
—
CA
Enumeration date
10/19/2006
Last updated
09/13/2017
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