Individual
ILIANA C MATIENZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
526 78TH ST, NORTH BERGEN, NJ 07047-4927
(551) 482-9205
Mailing address
526 78TH ST, NORTH BERGEN, NJ 07047-4927
(551) 482-9205
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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