Healthcare Provider Details

I. General information

NPI: 1437688157
Provider Name (Legal Business Name): MATTHEW EDWARD BITTNER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

9440 RUTLAND AVE
WHITTIER CA
90605-2830
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4666
  • Fax:
Mailing address:
  • Phone: 15623674766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95057280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: