Provider Demographics
NPI:1427592146
Name:MATIAS, ALICE JOHANIE (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:JOHANIE
Last Name:MATIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:JOHANIE
Other - Last Name:MATIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, BCBA
Mailing Address - Street 1:848 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7699
Mailing Address - Country:US
Mailing Address - Phone:407-963-1424
Mailing Address - Fax:407-678-8889
Practice Address - Street 1:15208 STONEBROOK DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773
Practice Address - Country:US
Practice Address - Phone:574-327-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB-1-19-38899103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst