Healthcare Provider Details

I. General information

NPI: 1487398707
Provider Name (Legal Business Name): MATTHEW MCCARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date: 01/31/2023
Reactivation Date: 05/15/2023

III. Provider practice location address

1525 W WESTMONT DR
ANAHEIM CA
92801-4736
US

IV. Provider business mailing address

1001 S EAST ST
ANAHEIM CA
92805-5749
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-8965
  • Fax:
Mailing address:
  • Phone: 714-517-8965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: