Provider Demographics
NPI:1063489557
Name:MATUNDAN, MITCHELL MARASIGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:MARASIGAN
Last Name:MATUNDAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 SANTA CRUZ EDIFICIO MEDICO
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-269-6391
Mailing Address - Fax:787-269-6442
Practice Address - Street 1:73 SANTA CRUZ EDIFICIO MEDICO
Practice Address - Street 2:SUITE 203
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-6391
Practice Address - Fax:787-269-6442
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH51417Medicare UPIN