Provider Demographics
NPI:1184848681
Name:MATIAS, ROSALEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROSALEE
Middle Name:
Last Name:MATIAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3576
Mailing Address - Street 2:BAYAMON GARDENS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-0576
Mailing Address - Country:US
Mailing Address - Phone:787-799-3391
Mailing Address - Fax:
Practice Address - Street 1:CARR 862 KM 2 HM 8
Practice Address - Street 2:SECT LO FRAILES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00958
Practice Address - Country:US
Practice Address - Phone:787-799-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5273183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5273OtherPT