1306977186 NPI number — MRS. LAURA IVETTE GALINDEZ MATOS MD

Table of content: MRS. LAURA IVETTE GALINDEZ MATOS MD (NPI 1306977186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306977186 NPI number — MRS. LAURA IVETTE GALINDEZ MATOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALINDEZ MATOS
Provider First Name:
LAURA
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1306977186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 AVE DE DIEGO
Provider Second Line Business Mailing Address:
PMB 700 SUITE 105
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00927-6372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-707-7854
Provider Business Mailing Address Fax Number:
787-706-7513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LA RIVIERA
Provider Second Line Business Practice Location Address:
1285 CALLE 54 SE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-707-7854
Provider Business Practice Location Address Fax Number:
787-706-7513
Provider Enumeration Date:
03/07/2007

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: 207RC0000X , with the licence number:  11380 , 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)





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