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General NPI Number Information
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NPI Number | 1235077660
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Entity Type | Individual
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Provider Name | FATIMA GABRIELA ARABIA MATAMOROS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 2023 VADALABENE DR STE 151
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City | MARYVILLE
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State | IL
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Zip | 62062-5845
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Country | US
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Telephone | 618-624-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 827 GARONNE DR
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City | MANCHESTER
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State | MO
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Zip | 63021-5655
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Country | US
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Telephone | 314-783-6301
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.034674
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License Number State | IL
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