Leodez

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

LEODEZ

Practice address

4292 Chamblee Tucker Rd
Tucker, GA 30084-2103

Phone

(770) 718-1517

NPI assigned

Nov 14, 2020

Organization subpart

Yes

Parent organization

B MATA LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Byron Oswaldo Mata, MD

Title

Owner

Phone

(786) 427-4450

Specialties & licenses 3

Addresses

Other names 1

• Centro Medico San Lucas Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

B Mata LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• B Mata LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Gainesville, GA
  • NPI 1295366292
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605312000000",
    "number": "1255933115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3899 GRASSLAND LOOP",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464120",
            "telephone_number": "407-394-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4292 CHAMBLEE TUCKER RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300842103",
            "telephone_number": "770-718-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEODEZ",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "B MATA LLC",
        "enumeration_date": "2020-11-14",
        "last_updated": "2020-11-14",
        "certification_date": "2020-11-14",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "OSWALDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-427-4450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centro Medico San Lucas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Legacy Chiropractic, Inc.
• Legacy Chiropractic, Inc.
• Sharon R Lehman, MD
• Leigh Enterprises
• Evelyn Theresa Leo, RD,LD,CDE
• Teresa Lev - Sniegowski, PT
• Lori C. Levey, LCSW
• Gregory Alan Lewis, PTA
• Luisa A Liendo, M.D
• Lifestar Response of Alabama

• General Practice Physician in Tucker, GA
• Providers in Tucker, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.