Provider Demographics
NPI:1053788349
Name:MATOS, ANNIKA
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26686 LITTLE JOHN CT APT 75
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7313
Mailing Address - Country:US
Mailing Address - Phone:239-297-3885
Mailing Address - Fax:
Practice Address - Street 1:5867 WHITAKER RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-2963
Practice Address - Country:US
Practice Address - Phone:239-774-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical