Provider Demographics
NPI:1932225976
Name:NG, MATTIANA SUSANA (CNM)
Entity Type:Individual
Prefix:
First Name:MATTIANA
Middle Name:SUSANA
Last Name:NG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24307 MAGIC MOUNTAIN PARKWAY
Mailing Address - Street 2:SUITE #145
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1808
Mailing Address - Country:US
Mailing Address - Phone:661-618-4277
Mailing Address - Fax:760-646-9719
Practice Address - Street 1:1420 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2508
Practice Address - Country:US
Practice Address - Phone:818-502-4567
Practice Address - Fax:818-502-4568
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN425028363L00000X
CA878367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner