1013831908 NPI number — NELCY MATA NP

Table of content: NELCY MATA NP (NPI 1013831908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013831908 NPI number — NELCY MATA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATA
Provider First Name:
NELCY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ- MATA
Provider Other First Name:
NELCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013831908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2404 FM 22 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75766-6555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
430-437-2981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 BUSY BEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75925-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-858-2327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2026

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: 363LF0000X , with the licence number:  1243670 , 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)