Provider Demographics
NPI:1104147933
Name:MATOS, MILTON EMILIO (PT)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:EMILIO
Last Name:MATOS
Suffix:
Gender:M
Credentials:PT
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 970
Mailing Address - Street 2:ZENO GANDIA APT. 426
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-554-0479
Mailing Address - Fax:787-881-9648
Practice Address - Street 1:STRRET #2 KM 65.6 BO. FACTOR I
Practice Address - Street 2:SUITE 201
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-881-9282
Practice Address - Fax:787-881-9648
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1688183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician