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General NPI Number Information
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NPI Number | 1629084710
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Entity Type | Individual
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Provider Name | MATTHEW J GARDINER MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 299 12TH ST
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City | MARINA
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State | CA
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Zip | 93933-6003
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Country | US
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Telephone | 831-647-7652
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Fax |
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Provider Business Mailing Address
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Address Line | 6672 SERVICEBERRY DR
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City | PARK CITY
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State | UT
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Zip | 84098-1518
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Country | US
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Telephone | 801-510-2543
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Fax | 801-614-7067
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 475067-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C159653
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License Number State | CA
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