NPIMap

Organization Active NPI

Carlos Mata P.a.

  • Plastic Surgery Physician
  • Crestview, FL
National Provider Identifier
1265778971
Registry record updated Dec 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
ME111574 Issued in FL
Legal business name
CARLOS MATA P.A.
Practice address
424 W Hwy 90
Crestview, FL 32536-2638
Phone
(850) 689-2260
NPI assigned
Dec 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2012

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

Authorized official

Name
Dr. Carlos Mata, M.D.
Title
Medical Director
Phone
(850) 920-3223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X ME111574 FL Primary

Addresses

Primary practice location

424 W Hwy 90
Crestview, FL 32536-2638

Mailing address

205 Tooke St
Fort Walton Beach, FL 32547-2681
Phone (850) 920-3223

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1356566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356566400000",
    "number": "1265778971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 TOOKE ST",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325472681",
            "telephone_number": "850-920-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W HWY 90",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362638",
            "telephone_number": "850-689-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOS MATA P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-27",
        "last_updated": "2012-12-27",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-920-3223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "ME111574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.