Healthcare Provider Details

I. General information

NPI: 1578543831
Provider Name (Legal Business Name): ROBERT JOHN MATYAS II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 AGNES AVE
STUDIO CITY CA
91607-4103
US

IV. Provider business mailing address

4450 AGNES AVE
STUDIO CITY CA
91607-4103
US

V. Phone/Fax

Practice location:
  • Phone: 808-388-1345
  • Fax:
Mailing address:
  • Phone: 808-388-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: