Healthcare Provider Details

I. General information

NPI: 1861648693
Provider Name (Legal Business Name): EMILIA MATOS M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 W 23RD ST
YUMA AZ
85364-8347
US

IV. Provider business mailing address

1073 W 23RD ST
YUMA AZ
85364-8347
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-0148
  • Fax: 928-783-7997
Mailing address:
  • Phone: 928-783-0148
  • Fax: 928-783-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number34699
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number37902
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12549
License Number StateAZ

VIII. Authorized Official

Name: DR. EMILA MATOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 928-783-0148