Healthcare Provider Details

I. General information

NPI: 1487590824
Provider Name (Legal Business Name): JACQUELINE ELIZABETH MATIAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 CLARK ST
TARZANA CA
91356-3501
US

IV. Provider business mailing address

3306 BRACE CANYON RD
BURBANK CA
91504-1653
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: