Provider Demographics
NPI:1831432285
Name:MATA, MARIA FERNANDA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:MATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S DOUGLAS RD
Mailing Address - Street 2:PH15
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7510
Mailing Address - Country:US
Mailing Address - Phone:786-493-5004
Mailing Address - Fax:
Practice Address - Street 1:888 S DOUGLAS RD
Practice Address - Street 2:PH15
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7510
Practice Address - Country:US
Practice Address - Phone:786-493-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst