Provider Demographics
NPI:1295366292
Name:B MATA LLC
Entity type:Organization
Organization Name:B MATA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:OSWALDO
Authorized Official - Last Name:MATA GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-427-4450
Mailing Address - Street 1:1631 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5942
Mailing Address - Country:US
Mailing Address - Phone:770-718-1517
Mailing Address - Fax:770-718-1518
Practice Address - Street 1:1631 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5942
Practice Address - Country:US
Practice Address - Phone:770-718-1517
Practice Address - Fax:770-718-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty