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General NPI Number Information
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NPI Number | 1174091508
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Entity Type | Individual
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Provider Name | ADRIANA MARIE MATOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/03/2018
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 250 W 5TH ST
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City | HANFORD
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State | CA
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Zip | 93230-5029
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Country | US
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Telephone | 305-322-7661
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Fax |
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Provider Business Mailing Address
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Address Line | 3404 S CRENSHAW ST APT A
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City | VISALIA
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State | CA
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Zip | 93277-8867
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Country | US
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Telephone | 305-322-7661
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 57328
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License Number State | CA
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