Individual
TIARA MATTOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 CASALS PL APT 13C, BRONX, NY 10475-3138
(917) 639-8277
Mailing address
120 CASALS PL APT 13C, BRONX, NY 10475-3138
(917) 639-8277
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
NY
Enumeration date
01/23/2022
Last updated
01/23/2022
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