Individual
MR. CARLOS FERNANDO MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4000 CAMBRIDGE ST, KANSAS CITY, KS 66160-8501
(913) 588-1227
Mailing address
4537 CAMBRIDGE ST, KANSAS CITY, KS 66103-3522
(816) 572-3894
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
43-557975-011
KS
Other
Enumeration date
06/06/2022
Last updated
06/06/2022
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