Charles Sedillo Mata, CO

NPI #1245438704 in Crestview, Florida

Provider Information

NPI Number: 1245438704
Entity Type: Individual
Name: Charles Sedillo Mata, CO
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: CO
Enumeration Date: Jul 6, 2007
Last Updated: Nov 1, 2007

Practice Location

Address: 4100 S FERDON BLVD
Address 2: B-4
City: Crestview
State: Florida
ZIP Code: 32536-5252
Phone: (850) 449-0380

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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