1699954669 NPI number — MARTA N MATOS PSY.D.

Table of content: MARTA N MATOS PSY.D. (NPI 1699954669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699954669 NPI number — MARTA N MATOS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATOS
Provider First Name:
MARTA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699954669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8525 SW 92ND ST
Provider Second Line Business Mailing Address:
B-8
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-7365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-598-8879
Provider Business Mailing Address Fax Number:
305-598-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8525 SW 92ND ST
Provider Second Line Business Practice Location Address:
B-8
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-7365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-598-8879
Provider Business Practice Location Address Fax Number:
305-598-0220
Provider Enumeration Date:
10/26/2007

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: 103TC0700X , with the licence number:  PY6307 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54756 . This is a "BLUECROSS BLUESHIELD PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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