Healthcare Provider Details

I. General information

NPI: 1417877275
Provider Name (Legal Business Name): MATTHEW ROOT DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 RIVERSIDE DR STE 212
SHERMAN OAKS CA
91423-2512
US

IV. Provider business mailing address

13320 RIVERSIDE DR STE 212
SHERMAN OAKS CA
91423-2512
US

V. Phone/Fax

Practice location:
  • Phone: 818-621-0019
  • Fax: 818-671-5556
Mailing address:
  • Phone: 818-621-0019
  • Fax: 818-671-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW S ROOT
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 818-621-0019