MEDICARE: DR. NICOLAS ROSARIO MATOS M.D.

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	208000000X	Pediatrics Physician	17587	PR

General Provider Information

NPI Number	:	1184827230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS ROSARIO MATOS M.D.

Provider Business Mailing Address
First Line	:	86 CALLE ANIS
Second Line	:	URB. CIUDAD JARDIN
City	:	CANOVANAS
State	:	PR
Zip	:	00729-9827
Country	:	US
Telephone Number	:	787-505-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	EDIF PLAZA SAN PABLO 1, SUITE 102
Second Line	:	PASEO SAN PABLO
City	:	BAYAMON
State	:	PR
Zip	:	00961-7018
Country	:	US
Telephone Number	:	787-709-4165
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	05/14/2026

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