Individual
THERESA ANN MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1208 GARDEN GRV, YUKON, OK 73099-4956
(918) 922-4817
Mailing address
1208 GARDEN GRV, YUKON, OK 73099-4956
(918) 922-4817
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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