Healthcare Provider Details

I. General information

NPI: 1932867488
Provider Name (Legal Business Name): MATA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5926 ORION DR
SEBRING FL
33872-1584
US

IV. Provider business mailing address

5926 ORION DR
SEBRING FL
33872-1584
US

V. Phone/Fax

Practice location:
  • Phone: 863-840-0639
  • Fax:
Mailing address:
  • Phone: 863-840-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ORLAND MATA CRUZ
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 863-840-0639