Provider Demographics
NPI:1043529969
Name:JOSE M MATOS
Entity Type:Organization
Organization Name:JOSE M MATOS
Other - Org Name:MEDI-TECH ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-206-1797
Mailing Address - Street 1:PO BOX 43002
Mailing Address - Street 2:SUITE 431
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-6601
Mailing Address - Country:US
Mailing Address - Phone:787-206-1797
Mailing Address - Fax:
Practice Address - Street 1:116 CALLE CARACOL
Practice Address - Street 2:URB VISTA DEL MAR
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-4513
Practice Address - Country:US
Practice Address - Phone:787-206-1797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier