Healthcare Provider Details

I. General information

NPI: 1902872914
Provider Name (Legal Business Name): PATRICIA E MATOS MOQUETE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CALLE MUNOZ RIVERA
PENUELAS PR
00624-1709
US

IV. Provider business mailing address

604 CALLE MUNOZ RIVERA
PENUELAS PR
00624-1723
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-3409
  • Fax:
Mailing address:
  • Phone: 787-836-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16181
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: