Individual
JOANNE MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
4411 E KINGS CANYON RD, FRESNO, CA 93702-3604
(559) 600-7180
Mailing address
8688 N CEDAR AVE APT 102, FRESNO, CA 93720-4826
(559) 600-7180
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT35103
CA
Other
Enumeration date
04/24/2014
Last updated
04/24/2014
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