Healthcare Provider Details

I. General information

NPI: 1407732373
Provider Name (Legal Business Name): ANGEL GUSTAVO RODRIGUEZ MATOS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALLE FLORENTINO ROMAN STE 120
CAROLINA PR
00987-6703
US

IV. Provider business mailing address

PO BOX 29775
SAN JUAN PR
00929-0775
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-4366
  • Fax: 787-768-4367
Mailing address:
  • Phone: 787-768-4366
  • Fax: 787-768-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8411
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: