Provider Demographics
NPI:1912184136
Name:MATAS-SOSA, ELLEN B (MSPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:B
Last Name:MATAS-SOSA
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:7500 SW 87TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5426
Mailing Address - Country:US
Mailing Address - Phone:305-913-0666
Mailing Address - Fax:305-913-0663
Practice Address - Street 1:7500 SW 87TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-913-0666
Practice Address - Fax:305-913-0664
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104441363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical