Active NPI
Paul Matala
- Pharmacist
- Port St Lucie, FL
National Provider Identifier
1801167283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS39644
- Practice address
- 1661 NW Saint Lucie West Blvd
Port St Lucie, FL 34986-2106 - Phone
- (772) 873-1892
- Fax
- (772) 873-1897
- NPI assigned
- Jan 18, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS39644 | FL | Primary |
Addresses
Primary practice location
1661 NW Saint Lucie West Blvd
Port St Lucie, FL 34986-2106
Mailing address
1661 NW Port St Lucie West Blvd
Port St Lucie, FL 34986
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS39644 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326844800000",
"number": "1801167283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1661 NW PORT ST LUCIE WEST BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "34986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1661 NW SAINT LUCIE WEST BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349862106",
"telephone_number": "772-873-1892",
"fax_number": "772-873-1897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATALA",
"first_name": "PAUL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-18",
"last_updated": "2012-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS39644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.