Provider Demographics
NPI:1679141592
Name:MATIAS, WALDEMAR (PA)
Entity type:Individual
Prefix:DR
First Name:WALDEMAR
Middle Name:
Last Name:MATIAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 3887
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-9595
Mailing Address - Country:US
Mailing Address - Phone:787-375-6977
Mailing Address - Fax:
Practice Address - Street 1:CANAS MEDICAL CENTER PLAZA GABRIELA CARR 132
Practice Address - Street 2:KM22.1 BO CANAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-212-3939
Practice Address - Fax:787-812-3931
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR318PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty