Individual
DAMIEN MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
505 S PACIFIC AVE, SAN PEDRO, CA 90731-2656
(310) 519-8723
Mailing address
244 W 14TH ST, SAN PEDRO, CA 90731-4315
(310) 519-8723
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-FMKVIZ
CA
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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