Individual
MR. CARLOS MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6838 W SUNSET BLVD, HOLLYWOOD, CA 90028-7008
(323) 461-3161
Mailing address
6838 W SUNSET BLVD, HOLLYWOOD, CA 90028-7008
(323) 461-3161
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/04/2016
Last updated
08/04/2016
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