Healthcare Provider Details

I. General information

NPI: 1992123046
Provider Name (Legal Business Name): OLGA MATATOVA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 N MILLER RD STE 102
SCOTTSDALE AZ
85251-3697
US

IV. Provider business mailing address

10046 N METRO PKWY W 115
PHOENIX AZ
85051-1437
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0008
  • Fax:
Mailing address:
  • Phone: 602-674-5515
  • Fax: 602-674-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5648
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: