Healthcare Provider Details

I. General information

NPI: 1205799665
Provider Name (Legal Business Name): ERIKA JULIA MATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 OSUNA RD NE
ALBUQUERQUE NM
87113-1391
US

IV. Provider business mailing address

3195 TURQUESA PL SE
RIO RANCHO NM
87124-5035
US

V. Phone/Fax

Practice location:
  • Phone: 505-441-0214
  • Fax: 913-222-1797
Mailing address:
  • Phone: 575-626-1348
  • Fax: 913-222-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65364
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: