Healthcare Provider Details

I. General information

NPI: 1467962787
Provider Name (Legal Business Name): SNEHA MATHEW MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E SAN MARCOS ST
PEARSALL TX
78061-3226
US

IV. Provider business mailing address

408 N GIRAUD
COTULLA TX
78014-3113
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-3336
  • Fax:
Mailing address:
  • Phone: 830-879-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: