Provider Demographics
NPI:1932270030
Name:MATTIOLI, CARLOS A
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:MATTIOLI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:A
Other - Last Name:MATTIOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:600 WICHITA AVE
Mailing Address - Street 2:# 501
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-3047
Mailing Address - Country:US
Mailing Address - Phone:713-444-6777
Mailing Address - Fax:
Practice Address - Street 1:900 BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-323-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4008207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology