Provider Demographics
NPI:1538171483
Name:MATUTES, ALINA (FNP)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:MATUTES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3653
Mailing Address - Country:US
Mailing Address - Phone:949-270-2100
Mailing Address - Fax:
Practice Address - Street 1:1550 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3653
Practice Address - Country:US
Practice Address - Phone:949-270-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX540934363L00000X
CA786689363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166757801Medicaid
166757802OtherCIDC
TX8C1681Medicare PIN
TX166757801Medicaid