Yeseniya Matatova
Individual provider Active NPI Pharmacist · Carefree, AZ
NPI 1356923866 · NPPES record last updated Apr 23, 2021
Key facts
- NPI
- 1356923866
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- S024210 (AZ)
- Practice address
- 5400 E Carefree Hwy
Carefree, AZ 85377-4417 - Phone
- (480) 595-6755
- NPI assigned
- Apr 23, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S024210 | AZ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S024210 | AZ | Yes |
Addresses
Primary practice location
5400 E Carefree Hwy
Carefree, AZ 85377-4417
Mailing address
5400 E Carefree Hwy
Carefree, AZ 85377-4417
NPI Registry JSON
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1356923866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 E CAREFREE HWY",
"city": "CAREFREE",
"state": "AZ",
"postal_code": "853774417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 E CAREFREE HWY",
"city": "CAREFREE",
"state": "AZ",
"postal_code": "853774417",
"telephone_number": "480-595-6755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATATOVA",
"first_name": "YESENIYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-23",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S024210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carefree, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.