Provider Demographics
NPI:1770384232
Name:MBUA, MATILDA NGOB (FNP)
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:NGOB
Last Name:MBUA
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 RIVERA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2415
Mailing Address - Country:US
Mailing Address - Phone:915-465-1191
Mailing Address - Fax:
Practice Address - Street 1:14900B GREG DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-9271
Practice Address - Country:US
Practice Address - Phone:915-465-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily