Provider Demographics
NPI:1740203439
Name:MATIAS, ISRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:MATIAS
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 1:506 CALLE ORQUIDEA
Mailing Address - Street 2:MOCA GARDENS
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4907
Mailing Address - Country:US
Mailing Address - Phone:787-410-2648
Mailing Address - Fax:
Practice Address - Street 1:506 CALLE ORQUIDEA
Practice Address - Street 2:MOCA GARDENS
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4907
Practice Address - Country:US
Practice Address - Phone:787-410-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14962208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics