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General NPI Number Information
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NPI Number | 1316451073
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Entity Type | Individual
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Provider Name | CHRISTIAN OSCAR MATOS MAUAD SURGICAL ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 12709 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33027-2902
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Country | US
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Telephone | 954-367-7984
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Fax | 954-367-7986
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Provider Business Mailing Address
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Address Line | 954 SW 4TH ST APT 2
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City | MIAMI
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State | FL
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Zip | 33130-2262
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Country | US
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Telephone | 305-588-4586
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 16-663
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License Number State | FL
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