Mattox, Tiara
Mattox, Tiara is an sole proprietor health care provider with primary practice located at 120 Casals Pl Apt 13C , Bronx NY 10475-3138. She recently has only one registered license in Respite Care Facility / Respite Care, Mental Retardation and/or Developmental Disabilities, which is considered as her primary health care specialty. Mattox, Tiara can be contacted via phone (917) 639-8277.Contact Information
Primary practice address
120 Casals Pl Apt 13C
Bronx NY 10475-3138
Phone: (917) 639-8277
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respite Care Facility / Respite Care, Mental Retardation and/or Developmental Disabilities | 385HR2060X |
Profile Details
| NPI number | 1194477901 |
|---|---|
| LBN Legal business name | Mattox, Tiara |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 23rd, 2022 |
| Last updated | Jan 23rd, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194477901 | NPPES |
| New York | MEDICAID | 000000000 |
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