Healthcare Provider Details

I. General information

NPI: 1073633137
Provider Name (Legal Business Name): LUZ E MATOS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA DEPT. OF SURGERY (112)
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

COND VILLAS DEL MONTE 6050 CARR. 844 BOX 28
SAN JUAN PR
00926-7814
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-4380
Mailing address:
  • Phone: 787-292-8066
  • Fax: 787-641-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number380788
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: