Individual
DR. ALICE Y. MATOBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6550 FANNIN ST, SUITE 1501, HOUSTON, TX 77030-2717
(713) 798-6100
(713) 798-4231
Mailing address
PO BOX 4771, HOUSTON, TX 77210-4771
(713) 798-6100
(713) 798-4231
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G4486
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136037202
—
TX
05
—
136037203
—
TX
01
—
2224669
BLUE LINK
TX
01
—
82W281
BC/BS
TX
Enumeration date
10/18/2005
Last updated
11/20/2020
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