Individual
MR. KELVIN RAFAEL MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2748 OCEAN AVE APT 4, BROOKLYN, NY 11229-4735
(646) 237-3450
Mailing address
2748 OCEAN AVE APT 4, BROOKLYN, NY 11229-4735
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/08/2017
Last updated
11/08/2017
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