1043247893 NPI number — DR. RAFAEL MATOS M.D.

Table of content: DR. RAFAEL MATOS M.D. (NPI 1043247893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043247893 NPI number — DR. RAFAEL MATOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATOS
Provider First Name:
RAFAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043247893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 937
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-2130
Provider Business Mailing Address Fax Number:
787-834-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59B CALLE MEDITACION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-2130
Provider Business Practice Location Address Fax Number:
787-834-2010
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  10360 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11324-04004780 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE3595 . This is a "PANAMERICAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 116-10360 . This is a "PLAN GLOBAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 212071 . This is a "UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00638 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 58392926 . This is a "SALUD BELLA VISTA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6800131 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 88848MA . This is a "TRIPLE-S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3732726 . This is a "FAMILY CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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