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General NPI Number Information
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NPI Number | 1518931377
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Entity Type | Individual
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Provider Name | NELSON A MATA MD
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 603 S NEBRASKA AVE
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City | SAN JUAN
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State | TX
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Zip | 78589-2647
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Country | US
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Telephone | 956-787-0669
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Fax | 956-787-2666
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Provider Business Mailing Address
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Address Line | 603 S NEBRASKA AVE
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City | SAN JUAN
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State | TX
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Zip | 78589-2647
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Country | US
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Telephone | 956-787-0669
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Fax | 956-787-2666
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J7075
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License Number State | TX
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