Provider Demographics
NPI:1609543909
Name:SAN MATEO, SANDEE C (PMHNP)
Entity Type:Individual
Prefix:
First Name:SANDEE
Middle Name:C
Last Name:SAN MATEO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 EASTLAKE PARKWAY,
Mailing Address - Street 2:SUITE 102 PMB 490
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:619-306-3920
Mailing Address - Fax:
Practice Address - Street 1:894 CAMINO CANTERA
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3332
Practice Address - Country:US
Practice Address - Phone:619-306-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018142363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health