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General NPI Number Information
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NPI Number | 1457867053
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Entity Type | Organization
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Legal Business Name | MATTHEW KILTHAU MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 956 WALNUT ST STE 200
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-1707
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Country | US
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Telephone | 805-203-6474
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Fax | 877-219-0743
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Provider Business Mailing Address
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Address Line | 302 WASHINGTON ST # 150-5243
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone |
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Fax | 877-219-0743
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW KILTHAU
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Credential | M.D.
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Telephone | 805-203-6474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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