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General NPI Number Information
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NPI Number | 1003814229
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Entity Type | Organization
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Legal Business Name | HARRY B. MATOSSIAN
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 234 HOSPITAL DR
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City | UKIAH
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State | CA
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Zip | 95482-4560
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Country | US
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Telephone | 707-462-3190
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Fax | 707-462-4647
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Provider Business Mailing Address
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Address Line | 234 HOSPITAL DR SUITE A
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City | UKIAH
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State | CA
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Zip | 95482-4560
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Country | US
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Telephone | 707-462-3190
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Fax | 707-462-4647
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Authorized Official
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Title or Position | OWNER
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Name | DR. HARRY BERJ MATOSSIAN
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Credential | M.D.
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Telephone | 707-462-3190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1100514
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License Number State | CA
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