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General NPI Number Information
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NPI Number | 1720284334
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Entity Type | Organization
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Legal Business Name | GRACE ZLAKET MATTA MD LLC
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Dates
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Enumeration Date | 06/21/2007
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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. STE 150
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7314
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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. STE 150
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7314
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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 | MEDICAL DIRECTOR - PRESIDENT
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Name | MRS. GRACE ZLAKET-MATTA
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Credential |
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Telephone | 480-219-5597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 23480
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License Number State | AZ
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