Fernando U Mata, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA12281 Issued in CA

Practice address

10200 Main St
Lamont, CA 93241-1700

Phone

(661) 845-1788

Fax

(661) 845-1791

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fernando Ulloa Mata Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: fernando.mata@3336.securemail.prognocis.com
• Direct secure messaging: fernando.mata@2871.securemail.prognocis.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505260800000",
    "number": "1063594117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 MAIN ST",
            "city": "LAMONT",
            "state": "CA",
            "postal_code": "932411700",
            "telephone_number": "661-845-1788",
            "fax_number": "661-845-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 MAIN ST",
            "city": "LAMONT",
            "state": "CA",
            "postal_code": "932411700",
            "telephone_number": "661-845-1788",
            "fax_number": "661-845-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "FERNANDO",
        "middle_name": "U",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2017-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA12281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA12281",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FERNANDO",
            "last_name": "MATA",
            "middle_name": "ULLOA",
            "credential": "PAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physician Assistant in Lamont, CA
• Providers in Lamont, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.