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General NPI Number Information
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NPI Number | 1225972011
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Entity Type | Individual
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Provider Name | DR. JAIME MATEUS
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Gender | Male
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Dates
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Enumeration Date | 04/14/2026
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 1 ROCKET RD
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City | HAWTHORNE
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State | CA
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Zip | 90250-6844
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Country | US
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Telephone | 617-308-0652
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Fax |
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Provider Business Mailing Address
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Address Line | 622 N GUADALUPE AVE UNIT C
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3069
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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