MEDICARE: DR. AMIDCAR JOSE MATOS IRIZARRY PSYD

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	103TC0700X	Clinical Psychologist	002415	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154400067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIDCAR JOSE MATOS IRIZARRY PSYD

Provider Business Mailing Address
First Line	:	URH TINTILLO GARDENS CALLE 6 H-16
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00966-0000
Country	:	US
Telephone Number	:	787-362-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 AVE FERNANDEZ JUNCOS SUITE 3C
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2616
Country	:	US
Telephone Number	:	787-362-3080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	06/28/2024

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