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General NPI Number Information
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NPI Number | 1841279650
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Entity Type | Individual
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Provider Name | KENNETH J MATTEONI MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 801 E WILLIAMS AVE
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City | FALLON
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State | NV
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Zip | 89406-3052
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Country | US
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Telephone | 775-867-7740
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Fax | 775-423-8871
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Provider Business Mailing Address
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Address Line | 801 E WILLIAMS AVE
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City | FALLON
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State | NV
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Zip | 89406-3052
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Country | US
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Telephone | 775-867-7757
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Fax | 775-423-8871
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 9079
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License Number State | NV
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