Provider Demographics
NPI:1306977186
Name:GALINDEZ MATOS, LAURA IVETTE (MD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:IVETTE
Last Name:GALINDEZ MATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 AVE DE DIEGO
Mailing Address - Street 2:PMB 700 SUITE 105
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6372
Mailing Address - Country:US
Mailing Address - Phone:787-707-7854
Mailing Address - Fax:787-706-7513
Practice Address - Street 1:LA RIVIERA
Practice Address - Street 2:1285 CALLE 54 SE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0000
Practice Address - Country:US
Practice Address - Phone:787-707-7854
Practice Address - Fax:787-706-7513
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11380207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG86848Medicare UPIN
PR89904Medicare ID - Type UnspecifiedPROVIDER NUMBER