Provider Demographics
NPI:1821063074
Name:ANTOMMATTEI, OSVALDO (MD)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:ANTOMMATTEI
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 10567
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0567
Mailing Address - Country:US
Mailing Address - Phone:787-840-0912
Mailing Address - Fax:787-840-0912
Practice Address - Street 1:1211 MUNOZ RIVERA AV
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0634
Practice Address - Country:US
Practice Address - Phone:787-840-0912
Practice Address - Fax:787-840-0912
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6034207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98597Medicare ID - Type Unspecified
D26724Medicare UPIN