Individual
DR. ERNESTO MATAMOROS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1695 SW 107TH AVE, MIAMI, FL 33165-7344
(305) 207-4443
(305) 207-4442
Mailing address
4179 W 9TH CT, HIALEAH, FL 33012-7201
(786) 282-4916
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME38894
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95778
BC BS OF FL PROVIDER NO
FL
01
—
ME38894
FL MEDICAL LICENSE NO
FL
Enumeration date
05/17/2006
Last updated
07/09/2007
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