Individual
GISELLE ALICIA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1212 W 17TH ST, SANTA ANA, CA 92706-3418
(714) 377-2348
(714) 377-2866
Mailing address
17360 BROOKHURST STREET, ATTN: CREDENTIALING DEPT., FOUNTAIN VALLEY, CA 92708-3720
(657) 241-3592
(714) 665-4614
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP19537
CA
Other
Enumeration date
05/06/2010
Last updated
05/20/2016
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