Provider Demographics
NPI:1316451073
Name:MATOS MAUAD, CHRISTIAN OSCAR (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:OSCAR
Last Name:MATOS MAUAD
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:954 SW 4TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2262
Mailing Address - Country:US
Mailing Address - Phone:305-588-4586
Mailing Address - Fax:
Practice Address - Street 1:12709 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2902
Practice Address - Country:US
Practice Address - Phone:954-367-7984
Practice Address - Fax:954-367-7986
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL16-663363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical