Individual
THELICIA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 743-0670
(210) 567-4659
Mailing address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 743-0670
(210) 567-4659
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1210733
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
1210733
TX
363LG0600X
Gerontology Nurse Practitioner
1210733
TX
Other
Enumeration date
08/27/2025
Last updated
11/04/2025
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