Provider Demographics
NPI:1083348197
Name:MATOS, MARIA PILAR
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PILAR
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 1:20 THATCHER ST # 2
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3231
Mailing Address - Country:US
Mailing Address - Phone:857-756-5864
Mailing Address - Fax:
Practice Address - Street 1:20 THATCHER ST # 2
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3231
Practice Address - Country:US
Practice Address - Phone:857-756-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2335616163WD1100X, 163WP2201X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care