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General NPI Number Information
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NPI Number | 1851027056
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Entity Type | Organization
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Legal Business Name | AMEER MATARIYEH A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 1990 WESTWOOD BLVD STE 220
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City | LOS ANGELES
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State | CA
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Zip | 90025-4674
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Country | US
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Telephone | 310-475-5377
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Fax | 310-446-1825
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Provider Business Mailing Address
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Address Line | 44938 16TH ST W
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City | LANCASTER
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State | CA
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Zip | 93534-2135
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Country | US
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Telephone | 661-471-2235
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Fax | 661-750-4292
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL AIDULIS
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Credential |
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Telephone | 661-471-2235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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