Provider Demographics
NPI:1649362690
Name:FRANCO-MATTA, AWILDA A (MD)
Entity type:Individual
Prefix:
First Name:AWILDA
Middle Name:A
Last Name:FRANCO-MATTA
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:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0986
Mailing Address - Country:US
Mailing Address - Phone:787-642-0404
Mailing Address - Fax:
Practice Address - Street 1:AVE CONQUISTADOR A-45
Practice Address - Street 2:URB MONTE BRISAS
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0986
Practice Address - Country:US
Practice Address - Phone:787-801-4854
Practice Address - Fax:787-801-4854
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13975208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55688Medicare UPIN
0020731Medicare ID - Type Unspecified