Provider Demographics
NPI:1689059214
Name:MATAS, JAIME ELISE
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:ELISE
Last Name:MATAS
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 1:21600 OXNARD ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4976
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:818-758-8015
Practice Address - Street 1:6930 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1845
Practice Address - Country:US
Practice Address - Phone:708-358-3000
Practice Address - Fax:708-524-0030
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst