Provider Demographics
NPI:1982480281
Name:MATRANGA, KASEN MARIE
Entity Type:Individual
Prefix:
First Name:KASEN
Middle Name:MARIE
Last Name:MATRANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASEN
Other - Middle Name:MARIE
Other - Last Name:BRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18072 DEBI LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2307
Mailing Address - Country:US
Mailing Address - Phone:714-809-9614
Mailing Address - Fax:
Practice Address - Street 1:9401 JERONIMO RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1908
Practice Address - Country:US
Practice Address - Phone:714-744-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty