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NPI Code Detail

MEDICARE: DR. ROY OOMEN MATHEW M.D.

MEDICARE: DR. ROY OOMEN MATHEW 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
1207RN0300XNephrology PhysicianA231100NY
2207RN0300XNephrology PhysicianA89504CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A231100OTHERNYSTATE LICENSE
2A89504OTHERCACA

General Provider Information

NPI Number : 1740298033
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROY OOMEN MATHEW M.D.
Provider Business Mailing Address
First Line : 11201 BENTON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92357-1000
Country : US
Telephone Number : 909-825-7084
Fax Number :
Provider Business Practice Location Address
First Line : 11201 BENTON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92357-1000
Country : US
Telephone Number : 909-825-7084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 01/29/2026

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