Doctor Name: | DAVID GUADALUPE MATA |
NPI Number: | 1790129815 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ANP |
License Number: | 619179 |
Business Practice Address: | 302 S. 5th Street Carrizo Springs, TX - 78834 |
Business Phone Number: | 8308769458 |
Business Fax Number: | |
Mailing Address: | 302 S. 5th Street, CARRIZO SPRINGS |
State: | TX |
Postal Code: | 78834 |
Phone Number: | 8308769458 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2013 |
NPI Last Update Date: | 04/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 619179 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |