Provider Demographics
NPI:1760683445
Name:DR. MATTEI I. M. CARE, PSC
Entity Type:Organization
Organization Name:DR. MATTEI I. M. CARE, PSC
Other - Org Name:H AUBREY FLEMING MATTEI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTEI LOUIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-728-2361
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:CALLE M PAVIA EDIT CHINEA 655
Practice Address - Street 2:STE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-728-2361
Practice Address - Fax:787-728-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG67890Medicare UPIN
0089578Medicare Oscar/Certification