Provider Demographics
NPI:1861648693
Name:EMILIA MATOS M.D. P.C.
Entity Type:Organization
Organization Name:EMILIA MATOS M.D. P.C.
Other - Org Name:PEDIATRIC ASSOCIATES OF YUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-783-0148
Mailing Address - Street 1:1073 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8347
Mailing Address - Country:US
Mailing Address - Phone:928-783-0148
Mailing Address - Fax:928-783-7997
Practice Address - Street 1:1073 W 23RD ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8347
Practice Address - Country:US
Practice Address - Phone:928-783-0148
Practice Address - Fax:928-783-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12549174400000X
AZ34699174400000X
AZ37902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty