Individual
DESERAY MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44226 10TH ST W, LANCASTER, CA 93534-4134
(661) 942-4719
Mailing address
17003 ZION DR, SANTA CLARITA, CA 91387-8808
(661) 526-9485
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
CA
172V00000X
Community Health Worker
Primary
—
CA
Other
Enumeration date
08/16/2023
Last updated
01/24/2024
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