Provider Demographics
NPI:1386971349
Name:MATIAS, JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:MATIAS
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 379
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0379
Mailing Address - Country:US
Mailing Address - Phone:787-897-2727
Mailing Address - Fax:787-897-2727
Practice Address - Street 1:CARR 111 KM 1.9
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-453-2478
Practice Address - Fax:787-897-2727
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR175572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry