Healthcare Provider Details

I. General information

NPI: 1801933288
Provider Name (Legal Business Name): MATTHEW S KOZLOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 NORDAHL ROAD SUITE 270
SAN MARCOS CA
92069-3596
US

IV. Provider business mailing address

2067 WINERIDGE PLACE SUITE A
ESCONDIDO CA
92029-1952
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-5955
  • Fax: 760-489-7150
Mailing address:
  • Phone: 760-489-5955
  • Fax: 760-489-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC55616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME108087
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40482
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number40482
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD12565
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number40482
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: