Provider Demographics
NPI:1437541331
Name:MATA, RUBEN (FNP)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MATA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 MEDICAL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3318
Mailing Address - Country:US
Mailing Address - Phone:210-558-0122
Mailing Address - Fax:210-558-0120
Practice Address - Street 1:4330 MEDICAL DR STE 500
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3318
Practice Address - Country:US
Practice Address - Phone:210-558-0122
Practice Address - Fax:210-558-0120
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257185163W00000X
TXAP127306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse