Provider Demographics
NPI:1023025269
Name:MATA, IRENE LOK-SZE (PA-C)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:LOK-SZE
Last Name:MATA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:LOK-SZE
Other - Last Name:SUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3860
Mailing Address - Country:US
Mailing Address - Phone:281-333-1300
Mailing Address - Fax:281-333-1303
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3860
Practice Address - Country:US
Practice Address - Phone:281-333-1300
Practice Address - Fax:281-333-1303
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03678363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N3516OtherBCBS
TX8N3516OtherBCBS