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General NPI Number Information
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NPI Number | 1336421726
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Entity Type | Individual
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Provider Name | CARLA M MATOS-RODRIGUEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 419 AVE PONCE DE LEON EDIFICIO METROPOLIS STE 102
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City | SAN JUAN
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State | PR
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Zip | 00917-3436
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Country | US
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Telephone | 787-754-0725
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Fax | 787-622-3490
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Provider Business Mailing Address
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Address Line | PO BOX 149793
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City | SAN JUAN
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State | PR
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Zip | 00919-4793
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Country | US
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Telephone | 787-410-6469
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Fax | 787-622-3490
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 19267
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License Number State | PR
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