Healthcare Provider Details

I. General information

NPI: 1881030161
Provider Name (Legal Business Name): MATTHEW ELGART PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD SUITE #400
PASADENA CA
91101-2039
US

IV. Provider business mailing address

595 E COLORADO BLVD SUITE #400
PASADENA CA
91101-2039
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-7691
  • Fax:
Mailing address:
  • Phone: 626-765-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number#259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: