Healthcare Provider Details

I. General information

NPI: 1932365632
Provider Name (Legal Business Name): CYRIL MATHAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 BALBOA PLACE
VAN NUYS CA
91406
US

IV. Provider business mailing address

8100 BALBOA PLACE
VAN NUYS CA
91406
US

V. Phone/Fax

Practice location:
  • Phone: 818-442-0529
  • Fax: 818-904-2358
Mailing address:
  • Phone: 818-442-0529
  • Fax: 818-904-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC42197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: