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NPI Code Detail

MEDICARE: MATO TOPA AUGUSTINE B.C.B.A

MEDICARE: MATO TOPA AUGUSTINE B.C.B.A
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
1103K00000XBehavior Analyst1-10-7442MA

General Provider Information

NPI Number : 1467898759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATO TOPA AUGUSTINE B.C.B.A
Provider Business Mailing Address
First Line : 3361 36TH ST SE
Second Line :
City : KENTWOOD
State : MI
Zip : 49512-2809
Country : US
Telephone Number : 616-942-2522
Fax Number :
Provider Business Practice Location Address
First Line : 3361 36TH ST SE
Second Line :
City : KENTWOOD
State : MI
Zip : 49512-2809
Country : US
Telephone Number : 616-942-2522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2013
Last Update Date : 05/14/2013

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