MEDICARE: OSVALDO ANTOMMATTEI MD

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	207RR0500X	Rheumatology Physician	6034	PR

General Provider Information

NPI Number	:	1821063074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSVALDO ANTOMMATTEI MD

Provider Business Mailing Address
First Line	:	PO BOX 10567
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-0567
Country	:	US
Telephone Number	:	787-840-0912
Fax Number	:	787-840-0912

Provider Business Practice Location Address
First Line	:	1211 MUNOZ RIVERA AV
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-0634
Country	:	US
Telephone Number	:	787-840-0912
Fax Number	:	787-840-0912

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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