Healthcare Provider Details

I. General information

NPI: 1124544929
Provider Name (Legal Business Name): ELSY MATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

17164 SW 112TH CT
MIAMI FL
33157-3907
US

V. Phone/Fax

Practice location:
  • Phone: 561-729-6631
  • Fax:
Mailing address:
  • Phone: 478-442-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: