Provider Demographics
NPI:1609477371
Name:MATOS RODRIGUEZ, ALBERTH
Entity Type:Individual
Prefix:
First Name:ALBERTH
Middle Name:
Last Name:MATOS RODRIGUEZ
Suffix:
Gender:M
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 836
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0836
Mailing Address - Country:US
Mailing Address - Phone:813-464-1418
Mailing Address - Fax:
Practice Address - Street 1:2232 COND VISTA REAL II
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-7853
Practice Address - Country:US
Practice Address - Phone:813-464-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program