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General NPI Number Information
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NPI Number | 1124117700
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Entity Type | Individual
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Provider Name | MATTHEW ROLAND NOTHERN NP PAC
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 3200 LONG BEACH BOULEVARD
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City | LONG BECH
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State | CA
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Zip | 90806-5062
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Country | US
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Telephone | 562-981-6865
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Fax | 562-595-6471
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Provider Business Mailing Address
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Address Line | 1600 E HILL STREET
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City | SIGNAL HILL
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State | CA
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Zip | 90755-3682
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Country | US
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Telephone | 562-424-6200
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Fax | 562-427-4634
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | A16544
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 13855
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License Number State | CA
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