NPIMap

Organization Active NPI

La Vida Medical Group Hatillo Corp

  • Family Medicine Physician
  • Hatillo, PR
National Provider Identifier
1033316856
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LA VIDA MEDICAL GROUP HATILLO CORP
Practice address
549 Calle del Mar
Suite 302
Hatillo, PR 00659-2869
Phone
(787) 880-2363
Fax
(787) 881-4312
NPI assigned
Jun 27, 2007
Last updated
May 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Diana I Matos
Title
Billing Manager
Phone
(787) 880-2363

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 13836 PR
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 000085 PR
Mammography Clinic/Center 261QR0206X

Addresses

Primary practice location

549 Calle del Mar
Suite 302
Hatillo, PR 00659-2869

Mailing address

549 Calle del Mar
Suite 302
Hatillo, PR 00659-2869
Phone (787) 880-2363

Other names 1

  • LOS ANGELES MEDICAL CLINIC Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1033316856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 CALLE DEL MAR",
            "address_2": "SUITE 302",
            "city": "HATILLO",
            "state": "PR",
            "postal_code": "006592869",
            "telephone_number": "787-880-2363",
            "fax_number": "787-881-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 CALLE DEL MAR",
            "address_2": "SUITE 302",
            "city": "HATILLO",
            "state": "PR",
            "postal_code": "006592869",
            "telephone_number": "787-880-2363",
            "fax_number": "787-881-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA VIDA MEDICAL GROUP HATILLO CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "MATOS",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "787-880-2363",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "PR",
            "license": "13836",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "PR",
            "license": "000085",
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LOS ANGELES MEDICAL CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hatillo, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.