Healthcare Provider Details

I. General information

NPI: 1851491849
Provider Name (Legal Business Name): EDWIN MATIAS, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W 3RD ST
LOS ANGELES CA
90057-1901
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-7953
  • Fax: 213-413-6338
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA46461
License Number StateCA

VIII. Authorized Official

Name: EDWIN MAUN MATIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-795-6596