Provider Demographics
NPI:1861448748
Name:MATOS, MARTA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE WINSTON CHURCHILL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6651
Mailing Address - Country:US
Mailing Address - Phone:787-759-8888
Mailing Address - Fax:787-792-2034
Practice Address - Street 1:200 AVE WINSTON CHURCHILL
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6651
Practice Address - Country:US
Practice Address - Phone:787-759-8888
Practice Address - Fax:787-792-2034
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice