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General NPI Number Information
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NPI Number | 1841868486
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Entity Type | Individual
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Provider Name | MICHELLE MATTSON
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Gender | Female
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 1690 SOUTHWEST EXPY
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City | SAN JOSE
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State | CA
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Zip | 95126-4400
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Country | US
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Telephone | 510-459-6804
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Fax |
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Provider Business Mailing Address
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Address Line | 527 HERMITAGE ST
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City | SAN JOSE
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State | CA
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Zip | 95134-1303
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Country | US
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Telephone | 925-389-7727
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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