Healthcare Provider Details

I. General information

NPI: 1326707480
Provider Name (Legal Business Name): MATTHEW PALL NRP, CP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E HILLCREST DR STE 110
THOUSAND OAKS CA
91360-4226
US

IV. Provider business mailing address

PO BOX 7741
WESTLAKE VILLAGE CA
91359-7741
US

V. Phone/Fax

Practice location:
  • Phone: 818-390-9444
  • Fax: 818-381-0007
Mailing address:
  • Phone: 818-390-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP32875
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number22-CCHW-00000
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code146E00000X
TaxonomyCommunity Paramedic
License Number377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: