Individual
ANGELA FAY MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35097933
OH
208000000X
Pediatrics Physician
Primary
4301086164
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053325
—
OH
01
—
07249
PARAMOUNT
OH
01
—
0H208910
BLUE CROSS GROUP
MI
01
—
72300
MERIDIAN
OH
01
—
9761739
AETNA
OH
Enumeration date
11/14/2007
Last updated
06/25/2014
Update your record
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