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General NPI Number Information
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NPI Number | 1851491849
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Entity Type | Organization
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Legal Business Name | EDWIN MATIAS, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 2131 W 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-1901
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Country | US
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Telephone | 213-484-7953
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Fax | 213-413-6338
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Provider Business Mailing Address
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Address Line | 225 S LAKE AVE 535
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City | PASADENA
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State | CA
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Zip | 91101-3005
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Country | US
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Telephone | 626-795-6596
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Fax | 626-795-8247
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN MAUN MATIAS
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Credential | M.D.
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Telephone | 626-795-6596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A46461
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License Number State | CA
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