Provider Demographics
NPI:1407732373
Name:RODRIGUEZ MATOS, ANGEL GUSTAVO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:GUSTAVO
Last Name:RODRIGUEZ MATOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29775
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0775
Mailing Address - Country:US
Mailing Address - Phone:787-768-4366
Mailing Address - Fax:787-768-4367
Practice Address - Street 1:100 CALLE FLORENTINO ROMAN STE 120
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-6703
Practice Address - Country:US
Practice Address - Phone:787-768-4366
Practice Address - Fax:787-768-4367
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist