Individual
MR. EDGAR IVAN MATAMOROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
5595 S UNIVERSITY DR, DAVIE, FL 33328-5307
(954) 276-3400
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN9397926
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023991800
—
FL
Enumeration date
10/25/2017
Last updated
03/19/2024
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