Provider Demographics
NPI:1871582239
Name:MATOBA, ALICE Y (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:Y
Last Name:MATOBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4771
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4771
Mailing Address - Country:US
Mailing Address - Phone:713-798-6100
Mailing Address - Fax:713-798-4231
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1501
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-798-6100
Practice Address - Fax:713-798-4231
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82W281OtherBC/BS
TX2224669OtherBLUE LINK
TX136037202Medicaid
TX136037203Medicaid