Provider Demographics
NPI:1144328329
Name:MATTIA, GERALDINE (MD)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:
Last Name:MATTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9595 COLLINS AVE
Mailing Address - Street 2:#403
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2618
Mailing Address - Country:US
Mailing Address - Phone:305-865-6559
Mailing Address - Fax:
Practice Address - Street 1:15055 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3365
Practice Address - Country:US
Practice Address - Phone:786-466-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0046504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0046504Medicare UPIN