Healthcare Provider Details

I. General information

NPI: 1770401010
Provider Name (Legal Business Name): MATTHEW T MEADOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WASHINGTON ST
SAN DIEGO CA
92103-2289
US

IV. Provider business mailing address

1808 3RD AVE APT 16
SAN DIEGO CA
92101-2627
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-8300
  • Fax:
Mailing address:
  • Phone: 619-729-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number49998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: