Provider Demographics
NPI:1740926351
Name:MATOS LASANTA, ANGELIRIS
Entity type:Individual
Prefix:
First Name:ANGELIRIS
Middle Name:
Last Name:MATOS LASANTA
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:PLAZA ESMERALDA AVE ESMERALDA
Mailing Address - Street 2:APT 227
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-374-5865
Mailing Address - Fax:
Practice Address - Street 1:PLAZA CHALET, AVE ALBOLOTE
Practice Address - Street 2:LOCAL #5
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-374-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor