Provider Demographics
NPI:1760845226
Name:MATAR, ABRAHAM
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:MATAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 OLIVE BRANCH RD
Mailing Address - Street 2:APT. 716
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7277
Mailing Address - Country:US
Mailing Address - Phone:321-750-8238
Mailing Address - Fax:
Practice Address - Street 1:4733 OLIVE BRANCH RD
Practice Address - Street 2:APT. 716
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7277
Practice Address - Country:US
Practice Address - Phone:321-750-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program