Provider Demographics
NPI:1215478326
Name:CYNTHIA MACE-MOTTA, DO PA
Entity type:Organization
Organization Name:CYNTHIA MACE-MOTTA, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACE-MOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-317-3775
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-310-3775
Mailing Address - Fax:972-294-3343
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 260
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-310-3775
Practice Address - Fax:972-294-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9185207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty