Healthcare Provider Details

I. General information

NPI: 1770503575
Provider Name (Legal Business Name): CLARE M MATNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. CLARE M SHERIDAN

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12402 INDUSTRIAL BLVD SUITE B-6
VICTORVILLE CA
92395-5871
US

IV. Provider business mailing address

12402 INDUSTRIAL BLVD SUITE B-6
VICTORVILLE CA
92395-5871
US

V. Phone/Fax

Practice location:
  • Phone: 760-780-1237
  • Fax: 877-780-3252
Mailing address:
  • Phone: 760-780-1237
  • Fax: 877-780-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA42818
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA42818
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberA42818
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA42818
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA42818
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA42818
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA42818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: