Provider Demographics
NPI:1992005383
Name:MATOS, MARYLIN
Entity Type:Individual
Prefix:
First Name:MARYLIN
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:
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 877
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-0877
Mailing Address - Country:US
Mailing Address - Phone:787-803-2807
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:BO MACHUELO TERRENOS HOSPITAL SAN LUCAS II FINAL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-840-6630
Practice Address - Fax:787-844-4130
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)