Provider Demographics
NPI:1306946173
Name:ANTOMATTEY DIETRICH, ANTONIE HILDA (MD)
Entity type:Individual
Prefix:
First Name:ANTONIE
Middle Name:HILDA
Last Name:ANTOMATTEY DIETRICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:CALLE EGIPTO 1306
Mailing Address - Street 2:PLAZA DE LA FUENTE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-1306
Mailing Address - Country:US
Mailing Address - Phone:787-787-9223
Mailing Address - Fax:787-787-9223
Practice Address - Street 1:CALLE J ESQUINA B SUITE 109
Practice Address - Street 2:EDIF MEDICO HNAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-9223
Practice Address - Fax:787-787-9223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2017-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE73858Medicare UPIN
PR0084616Medicare PIN