Provider Demographics
NPI:1912078320
Name:MATOS, JUAN M
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:M
Last Name:MATOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12565 ORANGE DR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4303
Mailing Address - Country:US
Mailing Address - Phone:954-274-2352
Mailing Address - Fax:
Practice Address - Street 1:12565 ORANGE DR
Practice Address - Street 2:SUITE 407
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4303
Practice Address - Country:US
Practice Address - Phone:954-274-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies