Provider Demographics
NPI:1699243022
Name:MATEO, ALIZAH MAE (PA-C)
Entity type:Individual
Prefix:
First Name:ALIZAH
Middle Name:MAE
Last Name:MATEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19192 FAIRHAVEN EXT
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1362
Mailing Address - Country:US
Mailing Address - Phone:949-290-9748
Mailing Address - Fax:
Practice Address - Street 1:19192 FAIRHAVEN EXT
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1362
Practice Address - Country:US
Practice Address - Phone:949-290-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center