Provider Demographics
NPI:1609124320
Name:MATANZO, TATIANA M I
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:M
Last Name:MATANZO
Suffix:I
Gender:F
Credentials:
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 745
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0745
Mailing Address - Country:US
Mailing Address - Phone:787-914-0846
Mailing Address - Fax:
Practice Address - Street 1:C/BALDORIOTY #12 ESQ. C/GEORGETTI
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program