Individual
DR. MARIANO DE LA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13506 SUMMERPORT VILLAGE PKWY, #341, WINDERMERE, FL 34786-7366
(865) 406-9069
Mailing address
PO BOX 100186, GAINESVILLE, FL 32610-0186
(352) 265-5911
(352) 265-5606
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
14898A
WY
207P00000X
Emergency Medicine Physician
19293
WV
207P00000X
Emergency Medicine Physician
ME99936
FL
207R00000X
Internal Medicine Physician
ME99936
FL
208000000X
Pediatrics Physician
ME99936
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3856126
—
TN
05
—
3943623
—
TN
01
—
4102788
BCBS OF TENNESSEE
TN
05
—
64049224
—
KY
Enumeration date
09/15/2006
Last updated
12/18/2025
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