Healthcare Provider Details

I. General information

NPI: 1124608708
Provider Name (Legal Business Name): GABRIELA ANDREINA MATA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA ANDREINA DA SILVA MD

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 SOUTH GRAND BLVD SLUCARE CENTER FOR SPECIALIZED MEDICINE
SAINT LOUIS MO
63104
US

IV. Provider business mailing address

1008 SOUTH SPRING AVENUE SLUCARE ACADEMIC PAVILION, 3RD FLOOR
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-6086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: