Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 30612 | TX |
Y | 1223E0200X | Endodontist | DN19592 | FL |
NPI | 1003173386 |
---|---|
Provider Name | Dr. Katia Mattos |
First Address | Miami, FL 33131-3790 |
Second Address | Miramar, FL 33027-4212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 02/12/2021 |