Provider Demographics
NPI:1902193170
Name:METATE MEDICAL, INC.
Entity Type:Organization
Organization Name:METATE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:951-684-4310
Mailing Address - Street 1:3538 CENTRAL AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2731
Mailing Address - Country:US
Mailing Address - Phone:714-922-0723
Mailing Address - Fax:
Practice Address - Street 1:3538 CENTRAL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2731
Practice Address - Country:US
Practice Address - Phone:951-684-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MALAMA FIRST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-07
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty