Provider Demographics
NPI:1124989942
Name:MATHURIN, MALETHEA J (NURSE)
Entity type:Individual
Prefix:
First Name:MALETHEA
Middle Name:J
Last Name:MATHURIN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 N CHEVY CHASE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-6032
Mailing Address - Country:US
Mailing Address - Phone:909-452-9700
Mailing Address - Fax:909-452-9700
Practice Address - Street 1:367 N CHEVY CHASE DR STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-6032
Practice Address - Country:US
Practice Address - Phone:909-452-9700
Practice Address - Fax:909-452-9700
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA007136893747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider