| Organization Name: | HARRY B. MATOSSIAN |
| NPI Number: | 1003814229 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HARRY BERJ MATOSSIAN (OWNER) |
| Mailing Address: | 234 Hospital Dr Ukiah |
| State: | CA US |
| Postal Code: | 954824560 |
| Phone Number: | 7074623190 |
| Fax Number: | 7074624647 |
| NPI Enumeration Date: | 07/12/2005 |
| NPI Last Update Date: | 09/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 1100514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |