Provider Demographics
NPI:1780785121
Name:MATEOS, YOLANDA MANTECON (MD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:MANTECON
Last Name:MATEOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 PINEDA CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7555
Mailing Address - Country:US
Mailing Address - Phone:321-254-8400
Mailing Address - Fax:321-254-7306
Practice Address - Street 1:445 PINEDA CT
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7555
Practice Address - Country:US
Practice Address - Phone:321-254-8400
Practice Address - Fax:321-254-7306
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME594152080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058052000Medicaid
FL058052000Medicaid