Provider Demographics
NPI:1316775711
Name:MATIENZO, PAUL MICHAEL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:MATIENZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 NE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5588
Mailing Address - Country:US
Mailing Address - Phone:305-582-6876
Mailing Address - Fax:
Practice Address - Street 1:1940 NE 35TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5588
Practice Address - Country:US
Practice Address - Phone:305-582-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver