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NPI Code Detail

MEDICARE: LISA MATA

MEDICARE: LISA MATA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-21-201699TX

General Provider Information

NPI Number : 1306579107
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MATA
Provider Business Mailing Address
First Line : 2743 SMITH RANCH RD UNIT 1202
Second Line :
City : PEARLAND
State : TX
Zip : 77584-5219
Country : US
Telephone Number : 281-835-4754
Fax Number :
Provider Business Practice Location Address
First Line : 2743 SMITH RANCH RD UNIT 1202
Second Line :
City : PEARLAND
State : TX
Zip : 77584-5219
Country : US
Telephone Number : 281-835-4754
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2022
Last Update Date : 07/08/2022

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Directions to “ LISA MATA ” Practice Location

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