Healthcare Provider Details

I. General information

NPI: 1003464561
Provider Name (Legal Business Name): MATRIX MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 SW 18TH TER
MIAMI FL
33155-1327
US

IV. Provider business mailing address

PO BOX 441598
MIAMI FL
33144-1598
US

V. Phone/Fax

Practice location:
  • Phone: 305-775-7760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO BURGOS-TIBURCIO
Title or Position: OWNER
Credential: MD
Phone: 305-775-7760