Healthcare Provider Details

I. General information

NPI: 1902783756
Provider Name (Legal Business Name): MATTHEW SIHOMBING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 LAUREL AVE
REDLANDS CA
92373-4838
US

IV. Provider business mailing address

1618 LAUREL AVE
REDLANDS CA
92373-4838
US

V. Phone/Fax

Practice location:
  • Phone: 909-801-1891
  • Fax:
Mailing address:
  • Phone: 909-801-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: