Healthcare Provider Details

I. General information

NPI: 1356835243
Provider Name (Legal Business Name): MATTHEW LAMON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE, BLDG 340, SUITE 201
VENTURA CA
93003
US

IV. Provider business mailing address

2323 KNOLL DR STE 219
VENTURA CA
93003-7307
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6100
  • Fax: 805-652-3252
Mailing address:
  • Phone: 805-677-5181
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A17818
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: