Individual
MICHELLE ROSE MATASSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
720 S COLORADO BLVD PH NORTH, DENVER, CO 80246-1904
(415) 424-4266
(415) 520-6633
Mailing address
8300 ESTERS BLVD STE 900, IRVING, TX 75063-2233
(415) 424-4266
(415) 520-6633
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003286770A
—
GA
05
—
100247515
—
CA
05
—
117508100
—
FL
05
—
15725553
—
CO
05
—
1720389927
—
TX
05
—
250017189
—
NV
05
—
830105664
—
MO
Enumeration date
11/04/2010
Last updated
05/20/2024
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