Individual
ERICKSON MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3201 CHERRY RIDGE ST STE 400, SAN ANTONIO, TX 78230-4820
(210) 692-0222
Mailing address
11710 PARLIAMENT ST APT 706, SAN ANTONIO, TX 78213-1167
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
189977
TX
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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