CHARLES MATA, CO

Specialist

Active Individual
NPI: 1245438704

Practice Address

4100 S FERDON BLVD
B-4
Crestview, FL 32536

Phone: (850) 449-0380

Specialties

Specialty Code Primary License
Specialist 174400000X Yes ORT157 (FL)

Frequently Asked Questions

NPI 1245438704 is the National Provider Identifier for CHARLES MATA, CO, a Specialist provider located in Crestview, FL. This NPI was enumerated on July 6, 2007.
CHARLES MATA, CO practices at 4100 S FERDON BLVD, B-4, Crestview, FL 32536.

Quick Facts

NPI
1245438704
Type
Individual
Enumerated
Jul 6, 2007
Last Updated
Nov 1, 2007

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