Provider Demographics
NPI:1427416239
Name:MATOS, ELGA ENID (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ELGA
Middle Name:ENID
Last Name:MATOS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 AVE ROBERTO SANCHEZ VILELLA
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2568
Mailing Address - Country:US
Mailing Address - Phone:787-762-3200
Mailing Address - Fax:
Practice Address - Street 1:819 AVE ROBERTO SANCHEZ VILELLA
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2568
Practice Address - Country:US
Practice Address - Phone:787-762-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9680183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician