Provider Demographics
NPI:1104977875
Name:MATHEWS, SENIORA (MD)
Entity type:Individual
Prefix:DR
First Name:SENIORA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SENIORA
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3422 BUSINESS CENTER DR.
Mailing Address - Street 2:STE 106 BOX 46
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0118
Mailing Address - Country:US
Mailing Address - Phone:870-530-1038
Mailing Address - Fax:
Practice Address - Street 1:468 N CAMDEN DR
Practice Address - Street 2:STE 353
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4507
Practice Address - Country:US
Practice Address - Phone:310-601-3074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN337882084P0800X
MS174802084P0800X
ARE21212084P0800X
CAA939222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A939220OtherMEDI-CAL
AR141604001Medicaid
CAEV392ZOtherMEDICARE PTAN
MS08808273Medicare ID - Type Unspecified
ARHO7122Medicare UPIN
CA00A939220OtherMEDI-CAL
AR5L218Medicare ID - Type Unspecified
TN3327151Medicare ID - Type Unspecified