1063555498 NPI number — YAMIL MATEO MD

Table of content: YAMIL MATEO MD (NPI 1063555498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063555498 NPI number — YAMIL MATEO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATEO
Provider First Name:
YAMIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1063555498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00751-0134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-824-0050
Provider Business Mailing Address Fax Number:
787-824-0050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 CALLE MONSERRATE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00751-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-824-0050
Provider Business Practice Location Address Fax Number:
787-824-0050
Provider Enumeration Date:
02/15/2007

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: 208D00000X , with the licence number:  6816 , 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: 28299 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7510006 . This is a "HUMANA ADVANTAGE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 069676 . This is a "CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400209 . This is a "MMM HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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