Provider Demographics
NPI:1043829583
Name:EUCEDA MATA, FRANCHESKA
Entity Type:Individual
Prefix:
First Name:FRANCHESKA
Middle Name:
Last Name:EUCEDA MATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 NW 17TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4554
Mailing Address - Country:US
Mailing Address - Phone:786-301-2251
Mailing Address - Fax:
Practice Address - Street 1:217 NW 17TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4554
Practice Address - Country:US
Practice Address - Phone:786-302-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty