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Individual
DIANA MATTA
Active
Individual
DIANA MATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
N004506
NY
213E00000X
Podiatrist
N004506
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01128578
—
NY
Enumeration date
12/05/2006
Last updated
10/10/2007
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