Provider Demographics
NPI:1093390163
Name:MATOS, MELVIN ALVARADO SR
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:ALVARADO
Last Name:MATOS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 15207
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9858
Mailing Address - Country:US
Mailing Address - Phone:787-613-5525
Mailing Address - Fax:
Practice Address - Street 1:BO JACAGUAS
Practice Address - Street 2:REPARTO BAYOAN CALLE 4 # 44
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-613-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other