=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184551376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAIMONA MATTA CERTIFIED PEER SPECI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2026
-----------------------------------------------------
Last Update Date | 05/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4040 S 188TH ST STE 300
-----------------------------------------------------
City | SEATAC
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-5070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-694-5700
-----------------------------------------------------
Fax | 206-694-5727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4040 S 188TH ST STE 300
-----------------------------------------------------
City | SEATAC
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-5070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-694-5700
-----------------------------------------------------
Fax | 206-694-5727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------