Individual
MS. AUDREA CELESTE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
3430 54TH ST, LUBBOCK, TX 79413-4042
(806) 407-4719
Mailing address
3430 54TH ST, LUBBOCK, TX 79413-4042
(806) 407-4719
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
209289
TX
Other
Enumeration date
02/22/2018
Last updated
02/22/2018
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