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General NPI Number Information
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NPI Number | 1588868616
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Entity Type | Individual
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Provider Name | MARIO MATOS-CRUZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 830 W HIGH ST STE 207
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City | LIMA
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State | OH
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Zip | 45801-3975
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Country | US
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Telephone | 419-996-4011
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Fax | 419-996-4012
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Provider Business Mailing Address
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Address Line | PO BOX 432
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City | PIKEVILLE
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State | KY
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Zip | 41502-0432
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Country | US
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Telephone | 606-218-6402
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Fax | 606-218-7502
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | C1-0027419
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 35065706
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License Number State | OH
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