Provider Demographics
NPI:1124608708
Name:MATA, GABRIELA ANDREINA (MD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ANDREINA
Last Name:MATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:ANDREINA
Other - Last Name:DA SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1008 SOUTH SPRING AVENUE
Mailing Address - Street 2:SLUCARE ACADEMIC PAVILION, 3RD FLOOR
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 SOUTH GRAND BLVD
Practice Address - Street 2:SLUCARE CENTER FOR SPECIALIZED MEDICINE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-977-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program