Healthcare Provider Details

I. General information

NPI: 1841180494
Provider Name (Legal Business Name): TORI MATO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DR
SAN ANTONIO TX
78229-2069
US

IV. Provider business mailing address

9514 CONSOLE DR
SAN ANTONIO TX
78229-2069
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number123785
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: