Healthcare Provider Details

I. General information

NPI: 1699268615
Provider Name (Legal Business Name): GULRAIZ MATLUB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36450 INLAND VALLEY DR
WILDOMAR CA
92595-9583
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax: 951-898-7320
Mailing address:
  • Phone: 909-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA173877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: