Healthcare Provider Details

I. General information

NPI: 1467668566
Provider Name (Legal Business Name): HELEN MATE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 RIDGEWOOD AVE. STE. 4
PORT ORANGE FL
32127-4544
US

IV. Provider business mailing address

1648 TAYLOR RD. #157
PORT ORANGE FL
32128
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-1000
  • Fax: 376-767-1001
Mailing address:
  • Phone: 386-767-1000
  • Fax: 386-767-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO2340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: