Victoria Lynn Mata

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

16045-RAC Issued in CA

Practice address

311 E Merced St
Fowler, CA 93625-2316

Phone

(559) 892-9452

NPI assigned

Sep 30, 2022

Last updated

Sep 30, 2022By the provider in NPPES

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prodigy Healthcare Non Profit

  • Adolescent and Children Mental Health Clinic/Center
  • Fowler, CA
  • NPI 1265158661
  NPD
• Prodigy Healthcare Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Selma, CA
  • NPI 1487164877
  NPD (past)

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

{
    "created_epoch": "1664496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1497479646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E MERCED ST",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936252316",
            "telephone_number": "559-892-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E MERCED ST",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936252316",
            "telephone_number": "559-892-9452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "VICTORIA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-30",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "16045-RAC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Luevano-Baker, B.A.
• Violet Eugenia Macias
• Danielle Malvini, D.O.
• Maria Maravilla
• Aaliyah Renee Mares
• Carly Jae Maxwell
• Medstar Lab Services LLC
• Guadalupe Melgoza
• Sarah Mendoza
• Tristan Philip Mero

• Addiction (Substance Use Disorder) Counselor in Fowler, CA
• Providers in Fowler, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; 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.