Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY24897 | CA |
Y | 103T00000X | Psychologist | PSY24897 | CA |
NPI | 1013035625 |
---|---|
Provider Name | Dr. Suzanne Yvette Mata Matranga |
First Address | La Puente, CA 91746-3211 |
Second Address | La Puente, CA 91746-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 22/07/2013 |