Provider Demographics
NPI:1538702683
Name:GRIFFIN, MATEASA D
Entity type:Individual
Prefix:MS
First Name:MATEASA
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 W. 82ND STREET
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305
Mailing Address - Country:US
Mailing Address - Phone:310-892-6051
Mailing Address - Fax:
Practice Address - Street 1:3017 W. 82ND STREET
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305
Practice Address - Country:US
Practice Address - Phone:310-892-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider