Provider Demographics
NPI:1477282101
Name:MATOS CONCEPCION, JUAN GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:GABRIEL
Last Name:MATOS CONCEPCION
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:HC 7 BOX 25881
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9670
Mailing Address - Country:US
Mailing Address - Phone:787-240-6479
Mailing Address - Fax:
Practice Address - Street 1:28 CALLE LIBERTAD
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1430
Practice Address - Country:US
Practice Address - Phone:787-240-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22731208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice