Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4010 | PR |
NPI | 1063447761 |
---|---|
Provider Name | Dr. Eduardo Mattei |
First Address | San Juan, PR 00908-0022 |
Second Address | San Juan, PR 00909-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
660368041 | TAX ID (01) | PR |
E08254 | (02) | PR |