Healthcare Provider Details

I. General information

NPI: 1225160351
Provider Name (Legal Business Name): SUBASH MATHEW M.D. FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 IROQUOIS WAY
FREMONT CA
94539-7127
US

IV. Provider business mailing address

611 IROQUOIS WAY
FREMONT CA
94539-7127
US

V. Phone/Fax

Practice location:
  • Phone: 510-226-6920
  • Fax: 510-226-6920
Mailing address:
  • Phone: 510-226-6920
  • Fax: 510-226-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC50844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: