CHARLES SEDILLO MATA (NPI# 1245438704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245438704 |
| Entity Type | Individual |
| Full Name | CHARLES SEDILLO MATA |
| Credential | CO |
| Practice Address |
4100 S Ferdon Blvd B-4 Crestview FL 32536-5252 |
| Mailing Address |
1920 E Hatton St Pensacola FL 32503-4842 |
| Practice Telephone | 8504490380 |
| Mailing Telephone | 8504490380 |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2007-11-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | ORT157 | FL | Other Service Providers |
| Street Address |
4100 S FERDON BLVD B-4 |
| City | CRESTVIEW |
| State | FL |
| Zip Code | 32536-5252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316996713 | Prime Therapy Inc | Physical Therapist | 4100 S Ferdon Blvd, Ste A1, Crestview, FL 32536-5252 | 2006-05-10 |
| 1114559465 | Jordan Taylor | Behavior Technician | 4100 S Ferdon Blvd, Crestview, FL 32536-5252 | 2020-02-05 |
| 1538710108 | Aubree A Davis | Behavior Technician | 4100 S Ferdon Blvd, Crestview, FL 32536-5252 | 2019-09-25 |
| 1396396495 | Desiray Lavon Greer | Behavior Technician | 4100 S Ferdon Blvd, Crestview, FL 32536-5252 | 2019-09-20 |
| 1154867554 | Cabana Eyes Optical | Clinic/Center | 4100 S Ferdon Blvd, Suite B5, Crestview, FL 32536-5252 | 2017-01-10 |
| 1184013385 | Allison Rivers | Speech-Language Pathologist | 4100 S Ferdon Blvd, Crestview, FL 32536-5252 | 2015-01-12 |
| 1821409228 | Nikki Leigh Justice | Speech-Language Pathologist | 4100 S Ferdon Blvd, Suite C1, Crestview, FL 32536-5252 | 2014-05-20 |
| 1770834988 | Courtney Celeste Miller | Occupational Therapist | 4100 S Ferdon Blvd, Crestview, FL 32536-5252 | 2012-09-27 |
| 1710271374 | Triple E Ot Inc | Occupational Therapist | 4100 S Ferdon Blvd, Suite C1, Crestview, FL 32536-5252 | 2011-06-01 |
| 1588958276 | Tonie Lyn Allen | Occupational Therapist | 4100 S Ferdon Blvd, Suite C1, Crestview, FL 32536-5252 | 2011-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831684901 | Eva Maria I Matute | Adult Companion | 6050 Trestle St, Crestview, FL 32536 | 2018-06-29 |
| 1669989232 | Lauren Estep Flowers | Physician Assistant | 550 Redstone Ave W Ste 370, Crestview, FL 32536 | 2018-01-04 |
| 1427444868 | Jessie Huisken | Social Worker | 5890 Saratoga Dr, Crestview, FL 32536 | 2015-04-13 |
| 1679846166 | John D. Carlson Md | Specialist | 492 North Wilson Street, Crestview, FL 32536 | 2012-02-15 |
| 1154609691 | Alternative Living, Inc. | Assisted Living Facility | 603 North Pearl Street, Crestview, FL 32536 | 2011-08-02 |
| 1487821526 | Michael G Foley Md Pa | Internal Medicine | 524 James Lee Blvd W, Crestview, FL 32536 | 2008-05-08 |
| 1184805830 | Advanced Family Medicine Clinic Inc | Family Medicine | 327 Medcrest Drive, Unit A, Crestview, FL 32536 | 2007-11-23 |
| 1164631511 | Caring Hearts Pediatric Extended Care Center, Inc | Clinic/Center | 380 Medcrest Dr, Crestview, FL 32536 | 2007-05-22 |
| 1669697751 | Crestview Chiropractic Clinic, Inc. | Chiropractor | 1078 S. Ferdon Boulevard, Suite A, Crestview, FL 32536 | 2007-04-16 |
| 1457492886 | Roy M Nakaiye | Dentist | 222 Cedar Ave, Crestview, FL 32536 | 2007-02-09 |
| Find all providers in zip 32536 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811250749 | Maria Rodriguez | Specialist | 6201 Flash Ln, Crestview, FL 32536-4367 | 2012-06-15 |
| 1679846166 | John D. Carlson Md | Specialist | 492 North Wilson Street, Crestview, FL 32536 | 2012-02-15 |
| 1831237460 | Stephen Arnold Schwartz | Specialist | 1408 Grandview Dr, Crestview, FL 32539-8519 | 2007-02-04 |
| 1932131596 | John Dale Carlson | Specialist | 492 N Wilson St, Crestview, FL 32536-3442 | 2006-07-06 |
| 1346295615 | Anesthesia and Pain Consultants, Pa | Specialist | 634 Riverwood Dr, Crestview, FL 32536-5008 | 2006-05-24 |
| 1245280858 | Shijun Pan | Specialist | 535 S Ferdon Blvd Ste C, Crestview, FL 32536-4446 | 2006-05-12 |
| 1770572745 | Alfred Cardet | Specialist | 550 W Redstone Ave, Suite300, Crestview, FL 32536-6429 | 2005-10-20 |
| 1649262650 | Marty P Gagliardi | Specialist | 127 E Redstone Ave, Suite B, Crestview, FL 32539-5358 | 2005-08-16 |
| 1700119443 | Bluewater Orthopedics, P.a. | Specialist | 120 E Redstone Ave, Suite B, Crestview, FL 32539-5370 | 2009-09-14 |
| 1063680528 | Okaloosa Pulmonary & Sleep Medicine Clinic | Specialist | 131 E Redstone Ave, Suite 105, Crestview, FL 32539-5326 | 2008-02-18 |
| Find all providers in CRESTVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.