Provider Demographics
NPI:1083611214
Name:MATEO, YADIRA G (MD)
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:G
Last Name:MATEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 CALLE BIANCA
Mailing Address - Street 2:URB TERRA SENORIAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9564
Mailing Address - Country:US
Mailing Address - Phone:787-365-0498
Mailing Address - Fax:
Practice Address - Street 1:172 CALLE BIANCA
Practice Address - Street 2:URB TERRA SENORIAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-9564
Practice Address - Country:US
Practice Address - Phone:787-365-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117742085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG57832Medicare UPIN
PR89147Medicare ID - Type Unspecified