Healthcare Provider Details

I. General information

NPI: 1548624836
Provider Name (Legal Business Name): NAWAR YOUSUF MATTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

PO BOX 104231
PASADENA CA
91189-4231
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-6383
  • Fax:
Mailing address:
  • Phone: 951-737-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA162517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: