Physician Compare National (NPI:1174688253)

HEALTHCARE PROVIDER: OLMAN MATA DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1174688253
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608924758
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090430000059
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MATA
	Individual professional last name
Provider First Name	OLMAN
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOS ANGELES COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	461 W BADILLO ST
	Group Practice or individual's line 1 address
City	COVINA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	917231834
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M