Healthcare Provider Details

I. General information

NPI: 1417328717
Provider Name (Legal Business Name): DR. JOSE R ARROYO MATOS CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 CALLE BALDORIOTY N
AIBONITO PR
00705-3218
US

IV. Provider business mailing address

PO BOX 1077
AIBONITO PR
00705-1077
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-4887
  • Fax:
Mailing address:
  • Phone: 787-735-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number8196
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8196
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number8196
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE RAMON ARROYO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 787-735-4887