Healthcare Provider Details

I. General information

NPI: 1740379072
Provider Name (Legal Business Name): CHERYL ANN MATOSSIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 E BIDWELL ST STE 110
FOLSOM CA
95630-6443
US

IV. Provider business mailing address

2545 E BIDWELL ST STE 110
FOLSOM CA
95630-6443
US

V. Phone/Fax

Practice location:
  • Phone: 916-941-7362
  • Fax: 866-779-3899
Mailing address:
  • Phone: 916-941-7362
  • Fax: 866-779-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA64163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: