Healthcare Provider Details

I. General information

NPI: 1952976763
Provider Name (Legal Business Name): JONATHAN MATOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 306
BAYAMON PR
00960-0306
US

IV. Provider business mailing address

17 CALLE SAN JOSE COND. FONTAINEBLEU VILLAGE APT. 1001
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-8181
  • Fax:
Mailing address:
  • Phone: 787-438-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: