Healthcare Provider Details

I. General information

NPI: 1285351122
Provider Name (Legal Business Name): MATTHEW ARIAS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MISSION ST. 3 NW OF 6TH AVE, MISSION ST
CARMEL-BY-THE-SEA CA
93921
US

IV. Provider business mailing address

PO BOX 2564
CARMEL BY THE SEA CA
93921-2564
US

V. Phone/Fax

Practice location:
  • Phone: 657-418-7140
  • Fax:
Mailing address:
  • Phone: 657-418-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000017039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: