Healthcare Provider Details

I. General information

NPI: 1700474210
Provider Name (Legal Business Name): JEYSLA MARIE MATOS CHAPARRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO MONACILLOS CENTRO MEDICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

BO MONACILLOS CENTRO MEDICO
SAN JUAN PR
00936
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-2786
  • Fax:
Mailing address:
  • Phone: 787-480-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24491
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: