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General NPI Number Information
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NPI Number | 1295104354
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Entity Type | Organization
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Legal Business Name | MATT REZA KHOSHNEVIS MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 3851 KATELLA AVE SUITE 315
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3309
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Country | US
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Telephone | 562-626-8016
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Fax |
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Provider Business Mailing Address
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Address Line | 3851 KATELLA AVE SUITE 315
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3309
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Country | US
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Telephone | 562-626-8016
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURA QUINONEZ
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Credential |
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Telephone | 562-626-8016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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