Individual
SHANTAL MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2385 CONLEY BLVD, FOUNTAIN, CO 80817-1509
(719) 243-7866
Mailing address
2385 CONLEY BLVD, FOUNTAIN, CO 80817-1509
(719) 243-7866
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
—
—
Other
Enumeration date
04/29/2025
Last updated
04/29/2025
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