Provider Demographics
NPI:1033309521
Name:MATHOS, MAISABEL ANA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MAISABEL
Middle Name:ANA
Last Name:MATHOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1619 S EXETER CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1108
Mailing Address - Country:US
Mailing Address - Phone:559-739-8439
Mailing Address - Fax:559-739-8439
Practice Address - Street 1:1619 S EXETER CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1108
Practice Address - Country:US
Practice Address - Phone:559-739-8439
Practice Address - Fax:559-739-8439
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14581311Z00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility