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General NPI Number Information
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NPI Number | 1144464454
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Entity Type | Individual
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Provider Name | LIA R MATARRESE MCGIBBON DO
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Gender | Female
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1910 COALTON RD
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City | SUPERIOR
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State | CO
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Zip | 80027-4674
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Country | US
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Telephone | 720-494-4700
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Fax | 720-494-4706
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 719-463-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 279671
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 50866
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License Number State | CO
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