Provider Demographics
NPI:1730109927
Name:MATOS, MARIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:MATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:MATOS-BERDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:125 CESSNA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-8111
Mailing Address - Country:US
Mailing Address - Phone:303-413-6301
Mailing Address - Fax:303-545-6942
Practice Address - Street 1:1333 IRIS AVENUE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2296
Practice Address - Country:US
Practice Address - Phone:303-413-6301
Practice Address - Fax:303-545-6942
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO358252084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F99469Medicare UPIN
C359978Medicare ID - Type Unspecified