Provider Demographics
NPI:1033708011
Name:MATEO, MIA ABIGAIL DALAG (NP)
Entity Type:Individual
Prefix:MRS
First Name:MIA ABIGAIL
Middle Name:DALAG
Last Name:MATEO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 CLAUDIED WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-1645
Mailing Address - Country:US
Mailing Address - Phone:916-582-4010
Mailing Address - Fax:
Practice Address - Street 1:5601 CLAUDIED WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-1645
Practice Address - Country:US
Practice Address - Phone:916-582-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily