Individual
ANDREA MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 N ROADRUNNER PKWY APT 2701, LAS CRUCES, NM 88011-2033
(575) 405-2351
Mailing address
501 N ROADRUNNER PKWY APT 2701, LAS CRUCES, NM 88011-2033
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-08861
NM
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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