Provider Demographics
NPI:1629596838
Name:MATIONG, LIZETTE LYNN (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:LIZETTE
Middle Name:LYNN
Last Name:MATIONG
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 FIRWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4635
Mailing Address - Country:US
Mailing Address - Phone:714-357-9020
Mailing Address - Fax:949-214-3284
Practice Address - Street 1:63 FIRWOOD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4635
Practice Address - Country:US
Practice Address - Phone:714-357-9020
Practice Address - Fax:949-214-3284
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591509163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225275688OtherMAIN STREET SPECIALTY SURGERY CENTER
CA1225275688OtherMSSSC