Individual
VELMA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
HIGHWAY 61 S, CRYSTAL CITY, MO 63019
(636) 933-1000
Mailing address
75 REMIT DRIVE, LOCKBOX 1131, CHICAGO, IL 60675-1131
(866) 916-5259
(231) 922-4060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2000166686
MO
363A00000X
Physician Assistant
Primary
2001003695
MO
363A00000X
Physician Assistant
85002144
IL
Other
Enumeration date
09/20/2006
Last updated
02/08/2008
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