Provider Demographics
NPI:1346309101
Name:MATA, FLORINA (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORINA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 S RICHFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5271
Mailing Address - Country:US
Mailing Address - Phone:303-671-6110
Mailing Address - Fax:303-369-7673
Practice Address - Street 1:3035 S PARKER RD
Practice Address - Street 2:STE 562
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2926
Practice Address - Country:US
Practice Address - Phone:303-671-6110
Practice Address - Fax:303-369-7673
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33175208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF74450Medicare UPIN