# LA VIDA MEDICAL GROUP HATILLO PT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073786547
- **Authorized official:** MRS. DIANA I MATOS (BILLING MANAGER)
- **Authorized official phone:** (787) 878-8155

## Contact information

- **Practice address:** 549 CALLE DEL MAR, SUITE 304, HATILLO, PR 00659-2869
- **Practice address phone:** (787) 878-8802
- **Practice address fax:** (787) 881-4312
- **Mailing address:** 549 CALLE DEL MAR, SUITE 304, HATILLO, PR 00659-2869
- **Mailing address phone:** (787) 878-8802
- **Mailing address fax:** (787) 881-4312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 707 | PR | Yes |

## Other

- **Enumeration date:** 04/07/2008
- **Last updated:** 04/07/2008