Individual
PAULA L. MATA-MOLINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8312 KASEMAN CT NE, ALBUQUERQUE, NM 87110-7639
(505) 291-5300
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
92-296
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000J2562
—
NM
Enumeration date
03/14/2007
Last updated
06/17/2022
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