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General NPI Number Information
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NPI Number | 1740523901
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Entity Type | Organization
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Legal Business Name | KENNETH M MATTOS AP LLC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4912 N ARMENIA AVE
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City | TAMPA
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State | FL
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Zip | 33603-1402
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Country | US
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Telephone | 813-871-2950
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Fax | 813-871-5972
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Provider Business Mailing Address
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Address Line | 4912 N ARMENIA AVE
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City | TAMPA
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State | FL
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Zip | 33603-1402
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Country | US
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Telephone | 813-871-2950
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Fax | 813-871-5972
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Authorized Official
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Title or Position | OWNER
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Name | MR. KENNETH M MATTOS
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Credential | DOM
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Telephone | 813-871-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2738
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License Number State | FL
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