Provider Demographics
NPI:1649305004
Name:MATOS-SEPULVEDA, MARIA M (MT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:MATOS-SEPULVEDA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:23 CALLE 7
Mailing Address - Street 2:RIVERSIDE PARK
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3505
Mailing Address - Country:US
Mailing Address - Phone:787-740-5606
Mailing Address - Fax:
Practice Address - Street 1:OFIC 102, 1ER. PISO
Practice Address - Street 2:EDIF. JOAQUIN MONTESINO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-785-3850
Practice Address - Fax:787-785-3850
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR5080246QH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematology