Provider Demographics
NPI:1184827230
Name:ROSARIO-MATOS, NICOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:ROSARIO-MATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 CALLE ANIS
Mailing Address - Street 2:URB. CIUDAD JARDIN
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9827
Mailing Address - Country:US
Mailing Address - Phone:787-505-2001
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL SAN JUAN
Practice Address - Street 2:BARRIO MONACILLO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-766-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics