Provider Demographics
NPI:1003817941
Name:MATTA, LUIS FEDERICO II (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FEDERICO
Last Name:MATTA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71205 HIGHWAY 21 STE 1
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7121
Mailing Address - Country:US
Mailing Address - Phone:985-809-8868
Mailing Address - Fax:
Practice Address - Street 1:71205 HIGHWAY 21 STE 1
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7121
Practice Address - Country:US
Practice Address - Phone:985-809-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019575207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5N272Medicare ID - Type Unspecified
LAE65824Medicare UPIN