Provider Demographics
NPI:1063406205
Name:MATTEI, JOSE A (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:MATTEI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140272
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0272
Mailing Address - Country:US
Mailing Address - Phone:787-880-2954
Mailing Address - Fax:787-880-3463
Practice Address - Street 1:301 MANUEL PEREZ AVILES STREET
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-2954
Practice Address - Fax:787-880-3463
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR44213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19928Medicare UPIN
0048060Medicare PIN