Provider Demographics
NPI:1104475250
Name:CARMONA MATOS, DANILEA MARIE (BS, MS)
Entity type:Individual
Prefix:
First Name:DANILEA
Middle Name:MARIE
Last Name:CARMONA MATOS
Suffix:
Gender:F
Credentials:BS, MS
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 4968
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4968
Mailing Address - Country:US
Mailing Address - Phone:787-743-3038
Mailing Address - Fax:
Practice Address - Street 1:AUTOPISTA LUIS A FERRE
Practice Address - Street 2:SALIDA 21 CARR 172 URB TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program