MEDICARE: TAPUWA D MATONDO M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program	RS 2014-0989	NM
2	207RI0200X	Infectious Disease Physician	75852	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780073742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAPUWA D MATONDO M.D.

Provider Business Mailing Address
First Line	:	2901 CORAL HILLS DR STE 220
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4146
Country	:	US
Telephone Number	:	954-345-0404
Fax Number	:	505-272-6845

Provider Business Practice Location Address
First Line	:	3100 CORAL HILLS DR STE 205
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4139
Country	:	US
Telephone Number	:	954-345-0404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	10/23/2023

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