Provider Demographics
NPI:1720389927
Name:MATASSA, MICHELLE ROSE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:MATASSA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:720 S COLORADO BLVD PH NORTH
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2024-05-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720389927Medicaid
MO830105664Medicaid
GA003286770AMedicaid
FL117508100Medicaid
NV250017189Medicaid
CO15725553Medicaid
CA100247515Medicaid