Provider Demographics
NPI:1306226592
Name:MATA, SANDRA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2904
Mailing Address - Country:US
Mailing Address - Phone:559-859-3551
Mailing Address - Fax:
Practice Address - Street 1:2212 ALMOND AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2904
Practice Address - Country:US
Practice Address - Phone:559-859-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN190123164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse