Provider Demographics
NPI:1730963257
Name:MATEO, HOWARD VERGARA
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:VERGARA
Last Name:MATEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12567 SW 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4719
Mailing Address - Country:US
Mailing Address - Phone:808-205-1483
Mailing Address - Fax:
Practice Address - Street 1:1925 NE STUCKI AVE UNIT 300
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6945
Practice Address - Country:US
Practice Address - Phone:503-906-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1091761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical