Individual
MRS. LIZETTE LYNN MATIONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
63 FIRWOOD, IRVINE, CA 92604-4635
(714) 357-9020
(949) 214-3284
Mailing address
63 FIRWOOD, IRVINE, CA 92604-4635
(714) 357-9020
(949) 214-3284
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
591509
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225275688
MAIN STREET SPECIALTY SURGERY CENTER
CA
Enumeration date
09/07/2017
Last updated
07/21/2022
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