Provider Demographics
NPI: | 1437503026 |
---|---|
Name: | MATOS SURGICAL FIRST ASSISTANT PLLC |
Entity Type: | Organization |
Organization Name: | MATOS SURGICAL FIRST ASSISTANT PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RASIEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MATOS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 281-463-6309 |
Mailing Address - Street 1: | 19618 LITTLE PINE LN |
Mailing Address - Street 2: | |
Mailing Address - City: | KATY |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77449-2673 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-463-6309 |
Mailing Address - Fax: | 281-463-6835 |
Practice Address - Street 1: | 19618 LITTLE PINE LN |
Practice Address - Street 2: | |
Practice Address - City: | KATY |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77449-2673 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-463-6309 |
Practice Address - Fax: | 281-463-6835 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-04-20 |
Last Update Date: | 2016-04-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Single Specialty |