Provider Demographics
NPI:1629103379
Name:MATTICE, MONICA A
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:MATTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E JUNIPERO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3524
Mailing Address - Country:US
Mailing Address - Phone:805-680-3332
Mailing Address - Fax:805-893-5424
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA
Practice Address - Street 2:STUDENT HEALTH
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-0001
Practice Address - Country:US
Practice Address - Phone:805-893-4084
Practice Address - Fax:805-893-5424
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily