Healthcare Provider Details

I. General information

NPI: 1235599168
Provider Name (Legal Business Name): MIGUEL ANGEL MATA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 N 10TH ST STE C2
MCALLEN TX
78504-3890
US

IV. Provider business mailing address

8135 FOREST LN # 515057
DALLAS TX
75230-2472
US

V. Phone/Fax

Practice location:
  • Phone: 956-558-0333
  • Fax: 956-600-7511
Mailing address:
  • Phone: 469-850-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: