Healthcare Provider Details

I. General information

NPI: 1629317425
Provider Name (Legal Business Name): TANIA MARIE MATIAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MUNICIPAL DE SAN JUAN CENTRO MEDICO MONACILLOS, RIO PIEDRAS
SAN JUAN PR
00936
US

IV. Provider business mailing address

PO BOX 763
BARRANQUITAS PR
00794-0763
US

V. Phone/Fax

Practice location:
  • Phone: 787-205-4464
  • Fax:
Mailing address:
  • Phone: 787-205-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19250
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: