Active NPI
Brian Jesse Mata
- Driver
- Los Angeles, CA
National Provider Identifier
1902504194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- Practice address
- 12021 South Wilmington Ave
Building 18 Suite 300
Los Angeles, CA 90059 - Phone
- (424) 454-6041
- NPI assigned
- Feb 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Primary |
Addresses
Primary practice location
12021 South Wilmington Ave
Building 18 Suite 300
Los Angeles, CA 90059
Mailing address
12021 South Wilmington Ave
Building 18 Suite 300
Los Angeles, CA 90059
Phone (424) 454-6041
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676592000000",
"number": "1902504194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12021 SOUTH WILMINGTON AVE",
"address_2": "BUILDING 18 SUITE 300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059",
"telephone_number": "424-454-6041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 SOUTH WILMINGTON AVE",
"address_2": "BUILDING 18 SUITE 300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059",
"telephone_number": "424-454-6041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATA",
"first_name": "BRIAN",
"middle_name": "JESSE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-02-17",
"last_updated": "2023-02-17",
"certification_date": "2023-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.