Provider Demographics
NPI:1366448102
Name:MACE-MOTTA, CYNTHIA A (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:MACE-MOTTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674325
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4325
Mailing Address - Country:US
Mailing Address - Phone:972-616-4000
Mailing Address - Fax:972-294-3343
Practice Address - Street 1:1600 W COLLEGE ST STE 260
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2101
Practice Address - Country:US
Practice Address - Phone:972-247-8757
Practice Address - Fax:972-401-9135
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9185207VG0400X, 207VM0101X, 207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100195004Medicaid
TX100195005OtherMEDICAID - OTHER
TX8F5170OtherBCBS
TX100195003Medicaid
TX366462YL7AOtherMEDICARE - OTHER COUNTY
TX100195003Medicaid