Individual
KARLA MATAELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6195 LUSK BLVD STE 250, SAN DIEGO, CA 92121-3715
(858) 859-1188
Mailing address
6195 LUSK BLVD STE 250, SAN DIEGO, CA 92121-3715
(858) 859-1188
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
7495099-1206
UT
363AM0700X
Medical Physician Assistant
Primary
PA21532
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7495099-1206
STATE LICENSE
UT
01
—
PA21532
DEPARMENT OF CONSUMER AFFAIRS PHYSCIAN ASSISTANT BOARD
CA
Enumeration date
11/03/2009
Last updated
11/07/2022
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