Provider Demographics
NPI:1033166129
Name:MATO, SAYONARA (MD, MPH&TM)
Entity Type:Individual
Prefix:DR
First Name:SAYONARA
Middle Name:
Last Name:MATO
Suffix:
Gender:F
Credentials:MD, MPH&TM
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:SAYONARA
Other - Last Name:PEREZ MATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH&TM
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:573-884-8526
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-6544
Practice Address - Fax:573-884-5226
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001026673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205765803Medicaid
MO205765803Medicaid
MO928505236Medicare PIN
MO928500635Medicare PIN