Provider Demographics
NPI:1619618600
Name:DOS ANJOS, JOSE A
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:DOS ANJOS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:ANTONIO TAVARES
Other - Last Name:DOS ANJOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN, OMS, DWC
Mailing Address - Street 1:115 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3185
Mailing Address - Country:US
Mailing Address - Phone:508-205-9724
Mailing Address - Fax:
Practice Address - Street 1:115 WEST ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3185
Practice Address - Country:US
Practice Address - Phone:508-205-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MART10198227900000X
MARN2304675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered