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General NPI Number Information
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NPI Number | 1467000240
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Entity Type | Individual
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Provider Name | IAN MAXWELL MATTHEWS PMHNP
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Gender | Male
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 13160 MINDANAO WAY STE 213
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6358
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Country | US
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Telephone | 925-282-1778
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Fax | 415-296-5299
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Provider Business Mailing Address
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Address Line | 13160 MINDANAO WAY STE 213
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6358
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Country | US
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Telephone | 925-282-1778
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Fax | 415-296-5299
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 889538
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2383657
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9636729
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95171771
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AC006045
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405126
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2383657
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License Number State | MA
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11027493
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP95014083
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License Number State | CA
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