Healthcare Provider Details

I. General information

NPI: 1154254159
Provider Name (Legal Business Name): MARIPOSA INTEGRATIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9147 SW 197TH CIR
DUNNELLON FL
34432-2685
US

IV. Provider business mailing address

9147 SW 197TH CIR
DUNNELLON FL
34432-2685
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-1814
  • Fax:
Mailing address:
  • Phone: 405-822-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALAYAH THRESA MATAMOROS
Title or Position: OWNER
Credential: APRN
Phone: 405-822-1814