Provider Demographics
NPI:1417194564
Name:MATOS, LYNES (CNMT,PET)
Entity Type:Individual
Prefix:MS
First Name:LYNES
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:CNMT,PET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SIERRA BAYAMON
Mailing Address - Street 2:15/5 15 ST. APT #5
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-593-2767
Mailing Address - Fax:787-620-8745
Practice Address - Street 1:SIERRA BAYAMON
Practice Address - Street 2:15/5 15 ST. APT #5
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-593-2767
Practice Address - Fax:787-620-8745
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1512471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology