Provider Demographics
NPI:1902910060
Name:MATEO, MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MATEO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2210 MESA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3756
Mailing Address - Country:US
Mailing Address - Phone:760-757-5841
Mailing Address - Fax:760-967-4863
Practice Address - Street 1:2210 MESA DR
Practice Address - Street 2:SUITE 5
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3756
Practice Address - Country:US
Practice Address - Phone:760-757-5841
Practice Address - Fax:760-967-4863
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANMW 884367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ39013Medicare UPIN