Healthcare Provider Details

I. General information

NPI: 1639332422
Provider Name (Legal Business Name): MARLON STEPHEN MATHEWS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N EL CIELO RD # D-402
PALM SPRINGS CA
92262-6972
US

IV. Provider business mailing address

275 N EL CIELO RD # D-402
PALM SPRINGS CA
92262-6972
US

V. Phone/Fax

Practice location:
  • Phone: 714-273-8285
  • Fax:
Mailing address:
  • Phone: 714-273-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA113109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: