Provider Demographics
NPI:1720046378
Name:MATTEI, JORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:MATTEI
Suffix:
Gender:M
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 19057
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1057
Mailing Address - Country:US
Mailing Address - Phone:787-728-2361
Mailing Address - Fax:787-728-6852
Practice Address - Street 1:655 CALLE PAVIA
Practice Address - Street 2:STE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2218
Practice Address - Country:US
Practice Address - Phone:787-728-2361
Practice Address - Fax:787-728-6852
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660584884OtherEIN
PR89578Medicare PIN
G67890Medicare UPIN