Provider Demographics
NPI:1548425408
Name:MATA, NAOMI R (MD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:R
Last Name:MATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9331 S COLORADO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7467
Mailing Address - Country:US
Mailing Address - Phone:303-471-4711
Mailing Address - Fax:303-471-4767
Practice Address - Street 1:9331 S COLORADO BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7467
Practice Address - Country:US
Practice Address - Phone:303-471-4711
Practice Address - Fax:303-471-4767
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA109591207Q00000X
CO0053583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program