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General NPI Number Information
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NPI Number | 1629317425
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Entity Type | Individual
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Provider Name | TANIA MARIE MATIAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | HOSPITAL MUNICIPAL DE SAN JUAN CENTRO MEDICO MONACILLOS, RIO PIEDRAS
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City | SAN JUAN
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State | PR
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Zip | 00936
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Country | US
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Telephone | 787-205-4464
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 763
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City | BARRANQUITAS
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State | PR
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Zip | 00794-0763
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Country | US
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Telephone | 787-205-4464
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 19250
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License Number State | PR
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