Provider Demographics
NPI:1700990744
Name:MATEO MINAYA, ZACARIAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACARIAS
Middle Name:A
Last Name:MATEO MINAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 357 SUITE 102 AVE TITO CASTRO #609
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-602-1331
Mailing Address - Fax:787-842-7836
Practice Address - Street 1:BO PASO SECO SECTOR USERAS CARR 153 KM 7.5
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-971-7186
Practice Address - Fax:787-842-7836
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80298Medicare ID - Type Unspecified