Healthcare Provider Details

I. General information

NPI: 1487518189
Provider Name (Legal Business Name): EDDY WILLIAM MATUS CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W WASHINGTON AVE
ESCONDIDO CA
92025-1643
US

IV. Provider business mailing address

550 W WASHINGTON AVE
ESCONDIDO CA
92025-1643
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-6308
  • Fax: 760-721-0351
Mailing address:
  • Phone: 760-489-6308
  • Fax: 760-721-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-IDZUVC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: