Provider Demographics
NPI:1477787497
Name:DENISSEJOVE MATOS GYNECOLOGY GROUP
Entity type:Organization
Organization Name:DENISSEJOVE MATOS GYNECOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOVE MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:13587
Authorized Official - Phone:1787-878-0861
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0946
Mailing Address - Country:US
Mailing Address - Phone:787-878-0861
Mailing Address - Fax:787-879-0148
Practice Address - Street 1:109 CALLE ANTONIO R BARC
Practice Address - Street 2:SUITE 3
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4724
Practice Address - Country:US
Practice Address - Phone:787-878-0861
Practice Address - Fax:787-879-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR110768Medicare UPIN