Organization Name: | DANIEL MATEMOTJA MD INC |
NPI Number: | 1063682979 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL MATEMOTJA (OWNER/MEDICAL DOCTOR) |
Mailing Address: | 12131 Carson St Hawaiian Gardens |
State: | CA US |
Postal Code: | 907161154 |
Phone Number: | 5628090299 |
Fax Number: | 5628092510 |
NPI Enumeration Date: | 03/06/2008 |
NPI Last Update Date: | 03/06/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A35512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |