Healthcare Provider Details

I. General information

NPI: 1669327672
Provider Name (Legal Business Name): JEAN MATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E UNION AVE UNIT 35
MESILLA PARK NM
88047-0018
US

IV. Provider business mailing address

310 E UNION AVE UNIT 35
MESILLA PARK NM
88047-0018
US

V. Phone/Fax

Practice location:
  • Phone: 331-308-4169
  • Fax:
Mailing address:
  • Phone: 331-308-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: