Jose A Matadama

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY34822 Issued in CA

Practice address

1720 E 120TH St
Los Angeles, CA 90059-3052

Phone

(310) 668-4447

NPI assigned

Sep 7, 2017

Last updated

May 7, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1487172631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "760-808-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593052",
            "telephone_number": "310-668-4447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16465 Sierra Lakes Pkwy Ste 140",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923361242",
            "country_code": "US",
            "telephone_number": "760-808-5177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATADAMA",
        "first_name": "JOSE",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY34822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryjane Mata
• Michael Anthony Mata, CRNA
• Yadira Yvette Mata
• Faasalalau Mataalii
• Herlene R Mataalii
• Michelle T Mataese
• Iliana Matamoros Castro
• Hirsch Matani, MD
• Nirosh Mataraarachchi, MD, MS
• Michelle Matayoshi

• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.