Provider Demographics
NPI:1881419018
Name:GARCIA MATOS, SAMUEL D
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:D
Last Name:GARCIA MATOS
Suffix:
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 1:1990 SE 40TH STREET RD APT B
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7195
Mailing Address - Country:US
Mailing Address - Phone:352-426-3009
Mailing Address - Fax:
Practice Address - Street 1:1990 SE 40TH STREET RD APT B
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-7195
Practice Address - Country:US
Practice Address - Phone:352-426-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL05627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty