Provider Demographics
NPI:1881335511
Name:SANTIAGO MATOS, PEDRO J (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:SANTIAGO MATOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:C18 URB SANTIAGO APOSTOL
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-1833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:C18 URB SANTIAGO APOSTOL
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-1833
Practice Address - Country:US
Practice Address - Phone:787-845-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR965-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant