Individual
MR. ISAIAS MATA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA03404
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA03404
TEXAS LICENSE
TX
Enumeration date
11/16/2007
Last updated
05/01/2024
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