Healthcare Provider Details

I. General information

NPI: 1265010771
Provider Name (Legal Business Name): EILEEN J MATOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N 35TH AVE
HOLLYWOOD FL
33021-5487
US

IV. Provider business mailing address

10915 NW 70TH ST
DORAL FL
33178-3741
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6301
  • Fax:
Mailing address:
  • Phone: 786-338-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number92493
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME182544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: