Individual
MR. FRED IGNACIO MATA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1885 LUNDY AVE, STE 223, SAN JOSE, CA 95131-1887
(408) 503-7960
Mailing address
1885 LUNDY AVE, STE 223, SAN JOSE, CA 95131-1887
(408) 503-7960
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/18/2008
Last updated
06/18/2008
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