Provider Demographics
NPI:1154643153
Name:NELSON A MATA
Entity Type:Organization
Organization Name:NELSON A MATA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:956-630-4155
Mailing Address - Street 1:603 S. NEBRASKA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2647
Mailing Address - Country:US
Mailing Address - Phone:956-787-0669
Mailing Address - Fax:956-787-2666
Practice Address - Street 1:603 SOUTH NEBRASKA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2647
Practice Address - Country:US
Practice Address - Phone:956-121-0663
Practice Address - Fax:956-787-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty