Provider Demographics
NPI:1710238977
Name:MATOS-MATOS, MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:MATOS-MATOS
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 1:6 CALLE SAN CARLOS
Mailing Address - Street 2:URB. MANSIONES DE CALDAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5330
Mailing Address - Country:US
Mailing Address - Phone:787-315-5190
Mailing Address - Fax:
Practice Address - Street 1:6 CALLE SAN CARLOS
Practice Address - Street 2:URB. MANSIONES DE CALDAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5330
Practice Address - Country:US
Practice Address - Phone:787-315-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology