MEDICARE: MISS PAULA ALEXANDRA MATOS M.A., BCABA

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
1	103K00000X	Behavior Analyst	0-09-3683	FL

General Provider Information

NPI Number	:	1487978672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAULA ALEXANDRA MATOS M.A., BCABA

Provider Business Mailing Address
First Line	:	4809 GORHAM AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-3178
Country	:	US
Telephone Number	:	407-516-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 GORHAM AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-3178
Country	:	US
Telephone Number	:	407-516-9171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/17/2010

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