Provider Demographics
NPI:1992123046
Name:MATATOVA, OLGA (PA-C)
Entity type:Individual
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First Name:OLGA
Middle Name:
Last Name:MATATOVA
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:10046 N METRO PKWY W
Mailing Address - Street 2:115
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1437
Mailing Address - Country:US
Mailing Address - Phone:602-674-5515
Mailing Address - Fax:602-674-3029
Practice Address - Street 1:10046 N METRO PKWY W
Practice Address - Street 2:115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1437
Practice Address - Country:US
Practice Address - Phone:602-674-5515
Practice Address - Fax:602-674-3029
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2023-09-16
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Provider Licenses
StateLicense IDTaxonomies
AZ5648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical