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NPI Code Detail

MEDICARE: DR. GERALDINE MATTIA MD

MEDICARE: DR. GERALDINE MATTIA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0046504NJ

General Provider Information

NPI Number : 1144328329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERALDINE MATTIA MD
Provider Business Mailing Address
First Line : 9595 COLLINS AVE
Second Line : #403
City : SURFSIDE
State : FL
Zip : 33154-2618
Country : US
Telephone Number : 305-865-6559
Fax Number :
Provider Business Practice Location Address
First Line : 15055 NW 27TH AVE
Second Line :
City : OPA LOCKA
State : FL
Zip : 33054-3365
Country : US
Telephone Number : 786-466-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/09/2007

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Directions to “ DR. GERALDINE MATTIA MD” Practice Location

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