Provider Demographics
NPI:1760594816
Name:MATA, JOSE JULIO (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JULIO
Last Name:MATA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE A-110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-595-9290
Mailing Address - Fax:305-595-5521
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE A-110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-595-9290
Practice Address - Fax:305-595-5521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 82032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272945800Medicaid
FLI39731Medicare UPIN
FLU5760ZMedicare ID - Type Unspecified