Provider Demographics
NPI:1689391880
Name:MATOS BERRIOS, KEILY
Entity Type:Individual
Prefix:
First Name:KEILY
Middle Name:
Last Name:MATOS BERRIOS
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 1:560 CALLE NAPOLES
Mailing Address - Street 2:COND. CONCORDIA GARDENS II APT 16E
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-359-9378
Mailing Address - Fax:
Practice Address - Street 1:560 CALLE NAPOLES
Practice Address - Street 2:COND. CONCORDIA GARDENS II APT 16E
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-359-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR87175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty