Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC6402 | TX |
NPI | 1194879312 |
---|---|
Provider Name | Dr. Shirley Ann Mata |
First Address | El Paso, TX 79996-2037 |
Second Address | El Paso, TX 79935-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 16/07/2014 |