Healthcare Provider Details

I. General information

NPI: 1447173083
Provider Name (Legal Business Name): MATTHEW SAYRE-JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W BROOKSIDE AVE
CHERRY VALLEY CA
92223-4073
US

IV. Provider business mailing address

2804 VALARIA DR
HIGHLAND CA
92346-2048
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1631
  • Fax:
Mailing address:
  • Phone: 909-362-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number741494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: