Healthcare Provider Details

I. General information

NPI: 1083004113
Provider Name (Legal Business Name): HECTOR LUIS MATIAS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

15925 SW 286TH ST
HOMESTEAD FL
33033-1194
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-2240
  • Fax:
Mailing address:
  • Phone: 786-383-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9214730
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9214730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: