Individual
MYRNA L. MATTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1409 DEVINE STREET, COLUMBIA, SC 29208-0001
(803) 777-3658
(803) 777-0126
Mailing address
1409 DEVINE STREET, COLUMBIA, SC 29208-0001
(803) 777-3658
(803) 777-0126
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
R106388
SC
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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