=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447476403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRIS A MATOS RIVERA M.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 CALLE 2 APT 158 COND PARQUE ARCOIRIS
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-367-3345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND PARQUE ARCOIRIS 227 CALLE 2 APT 158
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-367-3345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 7305
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------