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General NPI Number Information
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NPI Number | 1679564512
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Entity Type | Individual
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Provider Name | GRACE ZLAKET MATTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 9336 E RAINTREE DR STE150
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7322
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Country | US
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Telephone | 480-219-5597
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Fax | 480-219-5547
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Provider Business Mailing Address
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Address Line | 9336 E RAINTREE DR STE150
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7322
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Country | US
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Telephone | 480-219-5597
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Fax | 480-219-5547
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 23480
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License Number State | AZ
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