Mata, Jose

Mata, Jose is an sole proprietor health care provider with primary practice located at 4760 Sepulveda Blvd , Culver City CA 90230-4820. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Marriage & Family Therapist, Student, Health Care / Student in an Organized Health Care Education/Training Program. Behavioral Health & Social Service Providers / Marriage & Family Therapist is his primary health care specialty. Mata, Jose can be contacted via phone (917) 861-9671.

Contact Information

Primary practice address
4760 Sepulveda Blvd Culver City CA 90230-4820
Phone: (917) 861-9671
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1578807681
LBN Legal business name Mata, Jose
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 15th, 2012
Last updated Jan 6th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1578807681 NPPES
California MEDICAID 01261511

Popular Providers