Healthcare Provider Details

I. General information

NPI: 1043965312
Provider Name (Legal Business Name): SHAYLA MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5118 ESCALON AVE
VIEW PARK CA
90043-1624
US

IV. Provider business mailing address

5118 ESCALON AVE
VIEW PARK CA
90043-1624
US

V. Phone/Fax

Practice location:
  • Phone: 323-854-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: