Healthcare Provider Details

I. General information

NPI: 1598297301
Provider Name (Legal Business Name): ANGIE PATRICIA MATOS-HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N US HIGHWAY 1
FORT PIERCE FL
34950-9125
US

IV. Provider business mailing address

827 18TH ST
VERO BEACH FL
32960-6481
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-9900
  • Fax: 772-468-2364
Mailing address:
  • Phone: 772-925-8200
  • Fax: 772-925-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME147004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: