MEDICARE: NAOMI R MATA M.D.

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	207Q00000X	Family Medicine Physician	A109591	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	0053583	CO

General Provider Information

NPI Number	:	1548425408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI R MATA M.D.

Provider Business Mailing Address
First Line	:	31349 ROBINSON HILL RD
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-7754
Country	:	US
Telephone Number	:	312-451-6261
Fax Number	:	312-451-6261

Provider Business Practice Location Address
First Line	:	9331 S COLORADO BLVD
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7467
Country	:	US
Telephone Number	:	303-471-4711
Fax Number	:	303-471-4767

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	12/28/2024

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