Individual
ALEJANDRA JACQUELINE MATADAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12437 LEWIS ST STE 100, GARDEN GROVE, CA 92840-4651
(714) 202-0118
Mailing address
13634 LEMOLI AVE, HAWTHORNE, CA 90250-7722
(310) 702-3438
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
Y4840416
CA
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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