Provider Demographics
NPI:1093588246
Name:MOTA, MATHEUS
Entity Type:Individual
Prefix:
First Name:MATHEUS
Middle Name:
Last Name:MOTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 CHESHIRE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-0218
Mailing Address - Country:US
Mailing Address - Phone:239-321-4993
Mailing Address - Fax:
Practice Address - Street 1:5511 CHESHIRE DR APT 204
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0218
Practice Address - Country:US
Practice Address - Phone:239-321-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other