Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | J9185 | TX |
N | 207VG0400X | Gynecologist | J9185 | TX |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | J9185 | TX |
N | 207VX0000X | Obstetrician | J9185 | TX |
NPI | 1366448102 |
---|---|
Provider Name | Dr. Cynthia A Mace-Motta |
First Address | Dallas, TX 75267-4325 |
Second Address | Grapevine, TX 76051-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 30/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100195003 | (05) | TX |
100195004 | (05) | TX |
100195005 | MEDICAID - OTHER (01) | TX |
366462YL7A | MEDICARE - OTHER COUNTY (01) | TX |
8F5170 | BCBS (01) | TX |