Provider Demographics
NPI:1124580345
Name:MATTIA, COURTNEY (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MATTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9827 N 95TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4591
Mailing Address - Country:US
Mailing Address - Phone:808-608-4884
Mailing Address - Fax:
Practice Address - Street 1:9827 N 95TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4591
Practice Address - Country:US
Practice Address - Phone:480-860-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics