| Doctor Name: | MYRNA L. MATTOS |
| NPI Number: | 1619140340 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | R106388 |
| Business Practice Address: | 1409 Devine Street Columbia, SC - 292080001 |
| Business Phone Number: | 8037773658 |
| Business Fax Number: | 8037770126 |
| Mailing Address: | 1409 Devine Street, COLUMBIA |
| State: | SC |
| Postal Code: | 292080001 |
| Phone Number: | 8037773658 |
| Fax Number: | 8037770126 |
| NPI Enumeration Date: | 04/02/2008 |
| NPI Last Update Date: | 04/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | R106388 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |