Provider Demographics
NPI:1073972808
Name:MATESZ, DONALD (LAC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MATESZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 E AVALON DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7119
Mailing Address - Country:US
Mailing Address - Phone:602-954-8016
Mailing Address - Fax:
Practice Address - Street 1:6722 E AVALON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7119
Practice Address - Country:US
Practice Address - Phone:602-954-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0562171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist