Provider Demographics
NPI:1922036664
Name:SADI ANTONMATTEI MD CSP
Entity Type:Organization
Organization Name:SADI ANTONMATTEI MD CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SADI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANTONMATTEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-879-1199
Mailing Address - Street 1:PO BOX 141899
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1899
Mailing Address - Country:US
Mailing Address - Phone:787-879-1199
Mailing Address - Fax:
Practice Address - Street 1:179 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:REPARTO LOPEZ
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5723
Practice Address - Country:US
Practice Address - Phone:787-879-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5704261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27167Medicare ID - Type UnspecifiedPROVIDER NUMBER