Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-28405 | TX |
NPI | 1285148700 |
---|---|
Provider Name | Joanna Mata |
First Address | San Antonio, TX 78212 |
Second Address | San Antonio, TX 78248-0983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2017 |
Last Update Date | 20/11/2017 |