Provider Demographics
NPI:1558608190
Name:MATOS, OMAYRA (DC)
Entity Type:Individual
Prefix:DR
First Name:OMAYRA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C3 CALLE MARGINAL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2057
Mailing Address - Country:US
Mailing Address - Phone:787-600-1653
Mailing Address - Fax:787-626-7485
Practice Address - Street 1:SARDINERA BEACH BUILDING SUITE 1
Practice Address - Street 2:MARGINAL COSTA DE ORO
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-600-1653
Practice Address - Fax:787-626-7485
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor