Healthcare Provider Details

I. General information

NPI: 1578060679
Provider Name (Legal Business Name): OSVALDO ANDRES ANTOMMATTEI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 AVE ESMERALDA
GUAYNABO PR
00969-4448
US

IV. Provider business mailing address

PO BOX 10567
PONCE PR
00732-0567
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-0680
  • Fax: 787-790-7010
Mailing address:
  • Phone: 787-599-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6473
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: