Healthcare Provider Details

I. General information

NPI: 1447154539
Provider Name (Legal Business Name): MARIOES GHASSAN MATTHE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 COTTONWOOD VIEW DR
EL CAJON CA
92019-4643
US

IV. Provider business mailing address

3015 COTTONWOOD VIEW DR
EL CAJON CA
92019-4643
US

V. Phone/Fax

Practice location:
  • Phone: 619-249-8981
  • Fax:
Mailing address:
  • Phone: 619-249-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: