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General NPI Number Information
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NPI Number | 1790129815
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Entity Type | Individual
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Provider Name | DAVID GUADALUPE MATA JR. ANP
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Gender | Male
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 18707 HARDY OAK BLVD STE 530
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4791
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Country | US
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Telephone | 210-495-8280
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Fax | 210-481-3116
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Provider Business Mailing Address
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Address Line | 7913 BANDERA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78250-6511
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Country | US
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Telephone | 210-698-9841
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 619179
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License Number State | TX
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