Healthcare Provider Details

I. General information

NPI: 1700180866
Provider Name (Legal Business Name): MR. MATHIAS XAVIER CONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 11/28/2021
Certification Date: 11/28/2021
Deactivation Date: 06/08/2021
Reactivation Date: 11/26/2021

III. Provider practice location address

28 HANOVER LN STE B
CHICO CA
95973-7267
US

IV. Provider business mailing address

13562 SALINAS ST
LA GRANGE CA
95329-9458
US

V. Phone/Fax

Practice location:
  • Phone: 530-487-1342
  • Fax:
Mailing address:
  • Phone: 775-770-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: