Healthcare Provider Details

I. General information

NPI: 1669309894
Provider Name (Legal Business Name): MATHEW PERICLES CARVALHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935B SPRING ST
PLACERVILLE CA
95667-4523
US

IV. Provider business mailing address

1613 WENTWORTH AVE
SACRAMENTO CA
95822-1980
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6213
  • Fax:
Mailing address:
  • Phone: 916-533-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: