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General NPI Number Information
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NPI Number | 1831684901
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Entity Type | Individual
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Provider Name | EVA MARIA I MATUTE
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 6050 TRESTLE ST
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City | CRESTVIEW
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State | FL
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Zip | 32536
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Country | US
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Telephone | 910-528-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 6050 TRESTLE ST
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City | CRESTVIEW
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State | FL
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Zip | 32536-4379
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Country | US
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Telephone | 910-528-0612
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | FL
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