Provider Demographics
NPI:1356831028
Name:MATA SURGICAL ASSISTING
Entity Type:Organization
Organization Name:MATA SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LSA
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-687-4214
Mailing Address - Street 1:8100 PINEBROOK DR APT 1708
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4708
Mailing Address - Country:US
Mailing Address - Phone:210-687-4214
Mailing Address - Fax:
Practice Address - Street 1:8100 PINEBROOK DR APT 1708
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4708
Practice Address - Country:US
Practice Address - Phone:210-687-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherNO MEDICARE PIN