Provider Demographics
NPI:1174210801
Name:MATA, GEMAIMA CHRISTA (RN)
Entity type:Individual
Prefix:
First Name:GEMAIMA
Middle Name:CHRISTA
Last Name:MATA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37814 VERANDA WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4776
Mailing Address - Country:US
Mailing Address - Phone:760-216-9369
Mailing Address - Fax:619-924-8457
Practice Address - Street 1:37814 VERANDA WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4776
Practice Address - Country:US
Practice Address - Phone:760-216-9369
Practice Address - Fax:619-924-8457
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95250785163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse