Provider Demographics
NPI:1144635996
Name:MATOS, VERONICA (LPN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 BRUCKNER BLVD
Mailing Address - Street 2:5A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3743
Mailing Address - Country:US
Mailing Address - Phone:718-710-2547
Mailing Address - Fax:
Practice Address - Street 1:1770 BRUCKNER BLVD
Practice Address - Street 2:5A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3743
Practice Address - Country:US
Practice Address - Phone:718-710-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse