Healthcare Provider Details

I. General information

NPI: 1205761970
Provider Name (Legal Business Name): CAMBRIC MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 VAN NUYS BLVD
VAN NUYS CA
91405-4650
US

IV. Provider business mailing address

11604 KILLION ST
N HOLLYWOOD CA
91601-2638
US

V. Phone/Fax

Practice location:
  • Phone: 818-994-7614
  • Fax:
Mailing address:
  • Phone: 801-722-9243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: