MEDICARE: YADIRA G MATEO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician	11774	PR

General Provider Information

NPI Number	:	1083611214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADIRA G MATEO M.D.

Provider Business Mailing Address
First Line	:	172 CALLE BIANCA
Second Line	:	URB TERRA SENORIAL
City	:	PONCE
State	:	PR
Zip	:	00731-9564
Country	:	US
Telephone Number	:	787-365-0498
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 CALLE BIANCA
Second Line	:	URB TERRA SENORIAL
City	:	PONCE
State	:	PR
Zip	:	00731-9564
Country	:	US
Telephone Number	:	787-365-0498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/07/2011

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