Individual provider Active NPI

Karina Zambrano Mata

  • Marriage & Family Therapist
  • Glendora, CA
National Provider Identifier
1679236541
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT152492 Issued in CA
Practice address
1160 S Grand Ave
Glendora, CA 91740-5000
Phone
(626) 335-5980
NPI assigned
Oct 18, 2021
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT152492 CA Primary

Addresses

Primary practice location

1160 S Grand Ave
Glendora, CA 91740-5000

Mailing address

8490 Monte Vista St
Rancho Cucamonga, CA 91701-5425
Phone (323) 359-1962

Other identifiers 1

IdentifierTypeStateIssuer
101YM0800XMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250303003114 CA Practitioner - Marriage and Family Therapist 4789105099 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT152492CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Clinics Current Accepting new patients
Pacific Clinics CurrentSince Jan 6, 2025 Accepting new patients
Pacific Clinics CurrentSince Jan 6, 2025 Accepting new patients

Locations

251 Llewellyn Ave
Campbell, CA 95008
Phone (408) 364-4083

1160 S Grand Ave
Glendora, CA 91740
Phone (626) 335-5980

1020 S Arroyo Pkwy
Pasadena, CA 91105
Phone (626) 403-2794

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1679236541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8490 MONTE VISTA ST",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917015425",
            "telephone_number": "323-359-1962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 S GRAND AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917405000",
            "telephone_number": "626-335-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAMBRANO MATA",
        "first_name": "KARINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT152492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101YM0800X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.