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NPI Code Detail

MEDICARE: MATT SIDENER P.A.

MEDICARE: MATT SIDENER P.A.
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
1363A00000XPhysician AssistantPA15066CA

General Provider Information

NPI Number : 1477644730
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATT SIDENER P.A.
Provider Business Mailing Address
First Line : 1255 LIBERTY ST
Second Line :
City : REDDING
State : CA
Zip : 96001-0814
Country : US
Telephone Number : 530-246-2467
Fax Number : 530-242-9460
Provider Business Practice Location Address
First Line : 123 W NORTH BEAR CREEK DR
Second Line :
City : MERCED
State : CA
Zip : 95348-3420
Country : US
Telephone Number : 209-722-8161
Fax Number : 209-383-9211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 09/11/2020

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Directions to “ MATT SIDENER P.A.” Practice Location

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