Provider Demographics
NPI:1639195324
Name:MATOS, CANY
Entity Type:Individual
Prefix:
First Name:CANY
Middle Name:
Last Name:MATOS
Suffix:
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 1:70 CALLE AUTONOMIA
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3249
Mailing Address - Country:US
Mailing Address - Phone:787-876-2150
Mailing Address - Fax:787-256-3420
Practice Address - Street 1:70 CALLE AUTONOMIA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3249
Practice Address - Country:US
Practice Address - Phone:787-876-2150
Practice Address - Fax:787-256-3420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist