Healthcare Provider Details

I. General information

NPI: 1063406205
Provider Name (Legal Business Name): JOSE A. MATTEI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MANUEL PEREZ AVILES STREET
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 140272
ARECIBO PR
00614-0272
US

V. Phone/Fax

Practice location:
  • Phone: 787-880-2954
  • Fax: 787-880-3463
Mailing address:
  • Phone: 787-880-2954
  • Fax: 787-880-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number44
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: