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General NPI Number Information
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NPI Number | 1124214903
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Entity Type | Individual
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Provider Name | NELSON A. MATOS-FERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | CARRETERA 153 KM 7.3 PLAZA SANTA ISABEL SUITE 15
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City | SANTA ISABEL
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State | PR
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Zip | 00797-0000
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Country | US
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Telephone | 787-845-0805
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Fax | 787-845-0806
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Provider Business Mailing Address
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Address Line | PO BOX 937
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City | COAMO
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State | PR
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Zip | 00769-0937
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Country | US
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Telephone | 787-479-2608
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Fax | 787-845-0806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 16901
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License Number State | PR
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