Provider Demographics
NPI:1629317425
Name:MATIAS, TANIA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:MARIE
Last Name:MATIAS
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:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0763
Mailing Address - Country:US
Mailing Address - Phone:787-205-4464
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MUNICIPAL DE SAN JUAN CENTRO MEDICO
Practice Address - Street 2:MONACILLOS, RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-205-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics