Individual
LEONIDA MATA HYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6103 POTOMAC ST, SAN DIEGO, CA 92139-1730
(619) 802-8879
Mailing address
6103 POTOMAC ST, SAN DIEGO, CA 92139-1730
(619) 802-8879
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B6150363
DRIVER LICENSE
CA
Enumeration date
04/20/2020
Last updated
04/20/2020
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