Provider Demographics
NPI:1659197689
Name:ACOSTA-MATEO FAMILY NURSING MEDICAL PRACTICE
Entity type:Organization
Organization Name:ACOSTA-MATEO FAMILY NURSING MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:ACOSTA
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:361-219-0379
Mailing Address - Street 1:13949 BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 FULLERTON AVE STE 260
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3101
Practice Address - Country:US
Practice Address - Phone:361-219-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty