Healthcare Provider Details

I. General information

NPI: 1114391992
Provider Name (Legal Business Name): MATTHEW MCGARVEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 YORBA LINDA BLVD SUITE 204
YORBA LINDA CA
92886-4052
US

IV. Provider business mailing address

18300 YORBA LINDA BLVD SUITE 204
YORBA LINDA CA
92886-4052
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-6031
  • Fax:
Mailing address:
  • Phone: 714-577-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number52925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: