Healthcare Provider Details

I. General information

NPI: 1275552598
Provider Name (Legal Business Name): DAVID MATTHE SPEISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID MATTHE SPEISER MD

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 WEMBLEY RD
SAN MARINO CA
91108-1942
US

IV. Provider business mailing address

1444 WEMBLEY RD
SAN MARINO CA
91108-1942
US

V. Phone/Fax

Practice location:
  • Phone: 310-608-9074
  • Fax: 310-541-0042
Mailing address:
  • Phone: 424-212-2417
  • Fax: 310-541-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA45219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: