Provider Demographics
NPI:1598710998
Name:MATIAS, PEDRO F (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:F
Last Name:MATIAS
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:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1164
Mailing Address - Country:US
Mailing Address - Phone:787-258-6936
Mailing Address - Fax:
Practice Address - Street 1:EST DEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9570
Practice Address - Country:US
Practice Address - Phone:787-852-1400
Practice Address - Fax:787-852-5090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist