Individual
CHARLES SEDILLO MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO
Contact information
Practice address
4100 S FERDON BLVD, B-4, CRESTVIEW, FL 32536-5252
(850) 449-0380
Mailing address
1920 E HATTON ST, PENSACOLA, FL 32503-4842
(850) 449-0380
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ORT157
FL
Other
Enumeration date
07/06/2007
Last updated
11/01/2007
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