Provider Demographics
NPI:1790834539
Name:MATOS FIGUEROA, JORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:MATOS FIGUEROA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:PMB 153 SUITE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-259-3316
Mailing Address - Fax:787-259-3316
Practice Address - Street 1:LORRAINE MEDICAL BUILDING
Practice Address - Street 2:1681 AVE PASEO VILLA FLORES SUITE 203
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-259-3316
Practice Address - Fax:787-569-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11526146D00000X, 282NC0060X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88976Medicare ID - Type UnspecifiedINDIVIDUAL