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NPI Code Detail

MEDICARE: DR. MATTHEW J. BOSSE M.D.

MEDICARE:  DR. MATTHEW J. BOSSE  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistA75483CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A75483OTHERCASTATE LICENSE ID #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245239714
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW J. BOSSE M.D.
Provider Business Mailing Address
First Line : PO BOX 1168
Second Line :
City : LOS ANGELES
State : CA
Zip : 90078-1168
Country : US
Telephone Number : 323-993-7500
Fax Number : 323-308-4015
Provider Business Practice Location Address
First Line : 1625 SCHRADER BLVD
Second Line : 3RD FLOOR
City : LOS ANGELES
State : CA
Zip : 90028-6213
Country : US
Telephone Number : 323-993-7500
Fax Number : 323-308-4015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 03/07/2023

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Directions to “ DR. MATTHEW J. BOSSE M.D.” Practice Location

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