MEDICARE: DR. JORGE E MATTEI MD

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	11956	PR

General Provider Information

NPI Number	:	1720046378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE E MATTEI MD

Provider Business Mailing Address
First Line	:	PO BOX 19057
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-1057
Country	:	US
Telephone Number	:	787-728-2361
Fax Number	:	787-728-6852

Provider Business Practice Location Address
First Line	:	655 CALLE PAVIA
Second Line	:	STE 202
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2218
Country	:	US
Telephone Number	:	787-728-2361
Fax Number	:	787-728-6852

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/25/2014

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