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General NPI Number Information
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NPI Number | 1093600025
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Entity Type | Individual
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Provider Name | MATTHEW BENEDICT CORPUZ
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Gender | Male
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 12188 HESPERIA RD
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City | VICTORVILLE
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State | CA
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Zip | 92395-5822
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Country | US
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Telephone | 760-477-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 6925 CATABA RD
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City | OAK HILLS
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State | CA
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Zip | 92344-8661
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Country | US
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Telephone | 323-702-9730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-NDTXEW
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License Number State | CA
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