Individual
KEYNA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 E CROCKETT ST, CRYSTAL CITY, TX 78839-2720
(830) 694-2030
Mailing address
1305 E CROCKETT ST, CRYSTAL CITY, TX 78839-2720
(830) 694-2030
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
308299
TX
Other
Enumeration date
03/12/2021
Last updated
03/12/2021
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