Provider Demographics
NPI:1477617603
Name:MATIAS, JULIO M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:M
Last Name:MATIAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 CABO ALVERIO STREET
Mailing Address - Street 2:
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-753-1376
Mailing Address - Fax:787-767-0756
Practice Address - Street 1:557 CABO ALVERIO STREET
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-1376
Practice Address - Fax:787-767-0756
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0038213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26843Medicare UPIN
PR0048025Medicare ID - Type Unspecified