MEDICARE: ROSALYN YZETTA MATA

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	164X00000X	Licensed Vocational Nurse	185998	TX

General Provider Information

NPI Number	:	1568963460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN YZETTA MATA

Provider Business Mailing Address
First Line	:	270 COUNTY ROAD 3065
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-7790
Country	:	US
Telephone Number	:	903-767-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 COUNTY ROAD 3065
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-7790
Country	:	US
Telephone Number	:	903-767-8304
Fax Number	:

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

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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Directions to “ ROSALYN YZETTA MATA ” Practice Location

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