Healthcare Provider Details

I. General information

NPI: 1114039153
Provider Name (Legal Business Name): MATTHEW JOHN KATICS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E CHURCH ST STE 202
SANTA MARIA CA
93454-5915
US

IV. Provider business mailing address

1304 ELLA ST STE A
SAN LUIS OBISPO CA
93401-4165
US

V. Phone/Fax

Practice location:
  • Phone: 805-346-3456
  • Fax: 805-346-3454
Mailing address:
  • Phone: 805-549-9555
  • Fax: 805-549-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number20A9228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: