Healthcare Provider Details

I. General information

NPI: 1679804611
Provider Name (Legal Business Name): MATTHEW JAMES HOAG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 SANTA CLARA DR SUITE 200
SANTA CLARA UT
84765-5466
US

IV. Provider business mailing address

2711 SANTA CLARA DR SUITE 200
SANTA CLARA UT
84765-5466
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-9310
  • Fax: 435-674-9309
Mailing address:
  • Phone: 435-674-9310
  • Fax: 435-674-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number361629-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: