Healthcare Provider Details

I. General information

NPI: 1952218653
Provider Name (Legal Business Name): AJ MATTIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 MEDICAL CENTER DR
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

1132 LAVENDER LN
LA CANADA CA
91011-2339
US

V. Phone/Fax

Practice location:
  • Phone: 818-209-4430
  • Fax:
Mailing address:
  • Phone: 818-209-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AIDAS JOSEPH MATTIS
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 818-209-4430