Provider Demographics
NPI:1598297301
Name:MATOS-HERNANDEZ, ANGIE PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:PATRICIA
Last Name:MATOS-HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6637
Mailing Address - Country:US
Mailing Address - Phone:813-782-6064
Mailing Address - Fax:813-782-0984
Practice Address - Street 1:6712 DAIRY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6637
Practice Address - Country:US
Practice Address - Phone:813-782-6064
Practice Address - Fax:813-782-0984
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME147004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program