Provider Demographics
NPI:1447811245
Name:MATAMORO, JANETT (LPN)
Entity type:Individual
Prefix:
First Name:JANETT
Middle Name:
Last Name:MATAMORO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 N 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2943
Mailing Address - Country:US
Mailing Address - Phone:954-732-5215
Mailing Address - Fax:
Practice Address - Street 1:9050 PINES BLVD STE 362
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6400
Practice Address - Country:US
Practice Address - Phone:954-499-4005
Practice Address - Fax:954-499-4211
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5235787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse