Provider Demographics
NPI:1063555498
Name:MATEO, YAMIL (MD)
Entity type:Individual
Prefix:
First Name:YAMIL
Middle Name:
Last Name:MATEO
Suffix:
Gender:M
Credentials:MD
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 134
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0134
Mailing Address - Country:US
Mailing Address - Phone:787-824-0050
Mailing Address - Fax:787-824-0050
Practice Address - Street 1:74 CALLE MONSERRATE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3263
Practice Address - Country:US
Practice Address - Phone:787-824-0050
Practice Address - Fax:787-824-0050
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6816208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28299OtherTRIPLE S
PR7510006OtherHUMANA ADVANTAGE
PR069676OtherCRUZ AZUL DE PR
PR400209OtherMMM HEALTHCARE
PRE83759Medicare UPIN
PR7510006OtherHUMANA ADVANTAGE