Organization
HERMAN R MATALLANA DO PA
Active
Other names
Family Care ENT & Rec. surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERMAN R MATALLANA DO (PRESIDENT)
(863) 701-9510
Entity
Organization
Contact information
Practice address
5420 STRICKLAND AVE, LAKELAND, FL 33812-4264
(863) 701-9510
(863) 701-9518
Mailing address
5420 STRICKLAND AVE, LAKELAND, FL 33812-4264
(863) 701-9510
(863) 701-9518
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
OS7773
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208891
HEALTHEASE
FL
01
—
227021
AMERIGROUP
FL
05
—
264722200
—
FL
01
—
287598
AVMED
FL
01
—
9261729
PHCS PRIVATE HEALTHCARE
FL
01
—
N208891
STAYWELL
FL
01
—
V0004901
CITRUSCAID
FL
Enumeration date
12/13/2005
Last updated
10/14/2008
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