Individual
LISS MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 TAVELLA PL, FOOTHILL RANCH, CA 92610-2204
(949) 872-3369
Mailing address
44 TAVELLA PL, FOOTHILL RANCH, CA 92610-2204
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95006760
CA
Other
Enumeration date
06/20/2017
Last updated
11/18/2021
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