Individual
DAIVA MATTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(510) 872-2029
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(510) 872-2029
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
103343
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036.153139
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
103343
GA
Other
Enumeration date
04/10/2015
Last updated
02/26/2026
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