Individual
MR. MARIO DAVID MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00462
TX
363AS0400X
Surgical Physician Assistant
Primary
SA00462
TX
Other
Enumeration date
07/23/2012
Last updated
05/12/2026
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