Basic Information
| Provider Information | |||||||||
| NPI: | 1942440334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHER | ||||||||
| FirstName: | TREANNA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 S MAIN ST | ||||||||
| Address2: | 200 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146344567 | ||||||||
| FaxNumber: | 7146344569 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 S MAIN ST | ||||||||
| Address2: | 200 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146344567 | ||||||||
| FaxNumber: | 7146344569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2009 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA20026 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.