Healthcare Provider Details

I. General information

NPI: 1689157208
Provider Name (Legal Business Name): UMATTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 E PRICE RD STE D10
BROWNSVILLE TX
78521-2499
US

IV. Provider business mailing address

354 CARNAHAN ST
SAN ANTONIO TX
78209-6325
US

V. Phone/Fax

Practice location:
  • Phone: 833-628-8378
  • Fax:
Mailing address:
  • Phone: 210-882-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSANNA SHELTON
Title or Position: OWNER
Credential:
Phone: 210-882-7096