Provider Demographics
NPI:1316006430
Name:MATTA GONZALEZ, JORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:MATTA GONZALEZ
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:PO BOX 9634
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9634
Mailing Address - Country:US
Mailing Address - Phone:787-744-0857
Mailing Address - Fax:
Practice Address - Street 1:50 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:QUADRANGLE MEDICAL CENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3975
Practice Address - Country:US
Practice Address - Phone:787-744-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR159592084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry