Healthcare Provider Details

I. General information

NPI: 1902251143
Provider Name (Legal Business Name): MATTHEW BRYAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S AKERS ST
VISALIA CA
93277-8311
US

IV. Provider business mailing address

9903 SANTA MONICA BLVD # 2700
BEVERLY HILLS CA
90212-1671
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-3300
  • Fax:
Mailing address:
  • Phone: 310-913-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A15742
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A15742
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number20A15742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: