Provider Demographics
NPI:1760237598
Name:MATTHEW, DANIELEA TESIA
Entity Type:Individual
Prefix:MISS
First Name:DANIELEA
Middle Name:TESIA
Last Name:MATTHEW
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 1:10580 COLOMA ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2002
Mailing Address - Country:US
Mailing Address - Phone:951-483-0850
Mailing Address - Fax:
Practice Address - Street 1:10580 COLOMA ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2002
Practice Address - Country:US
Practice Address - Phone:951-483-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist