MEDICARE: CYNTHIA MATHIS MD A PROFESSIONAL CORPORATION

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
1	208VP0000X	Pain Medicine Physician	G79441	CA

General Provider Information

NPI Number	:	1801160460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA MATHIS MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 9789
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90295-2189
Country	:	US
Telephone Number	:	310-577-8500
Fax Number	:	310-305-7119

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3624
Country	:	US
Telephone Number	:	310-641-8111
Fax Number	:	310-337-7274

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CYNTHIA M MATHIS
Credential	:	M.D.
Telephone Number	:	310-641-8111

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	07/21/2022

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