Provider Demographics
NPI:1841650934
Name:MATA, JASON SR
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MATA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3801
Mailing Address - Country:US
Mailing Address - Phone:210-212-7700
Mailing Address - Fax:210-212-7700
Practice Address - Street 1:1600 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3801
Practice Address - Country:US
Practice Address - Phone:210-212-7700
Practice Address - Fax:210-212-7700
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports