1023025269 NPI number — IRENE LOK-SZE MATA PA-C

Table of content: IRENE LOK-SZE MATA PA-C (NPI 1023025269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023025269 NPI number — IRENE LOK-SZE MATA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATA
Provider First Name:
IRENE
Provider Middle Name:
LOK-SZE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUNG
Provider Other First Name:
IRENE
Provider Other Middle Name:
LOK-SZE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023025269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18333 EGRET BAY BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77058-3860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-333-1300
Provider Business Mailing Address Fax Number:
281-333-1303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18333 EGRET BAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-333-1300
Provider Business Practice Location Address Fax Number:
281-333-1303
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA03678 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8N3516 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com