MEDICARE: DRMATIASHEALTHCENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1093348062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRMATIASHEALTHCENTER

Provider Business Mailing Address
First Line	:	5150 BELFORT RD BLDG 400
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 BELFORT RD BLDG 400
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6026
Country	:	US
Telephone Number	:	904-868-1887
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANNABELLE M MATIAS-LEON
Credential	:	MD
Telephone Number	:	904-868-1887

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	02/19/2020

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Directions to “DRMATIASHEALTHCENTER ” Practice Location

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