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General NPI Number Information
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NPI Number | 1407949985
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Entity Type | Individual
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Provider Name | KIMBERLY MATTA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 18400 KATY FWY SUITE 530
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City | HOUSTON
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State | TX
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Zip | 77094-1286
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Country | US
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Telephone | 281-717-4003
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Fax | 281-206-7597
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Provider Business Mailing Address
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Address Line | 929 GESSNER RD STE 2200
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City | HOUSTON
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State | TX
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Zip | 77024-2583
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Country | US
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Telephone | 713-337-5277
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08479
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2204
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA8479
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License Number State | TX
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