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General NPI Number Information
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NPI Number | 1871516922
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Entity Type | Individual
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Provider Name | STANLEY K. MATHIS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 1701 E CESAR E CHAVEZ AVE SUITE #510
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City | LOS ANGELES
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State | CA
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Zip | 90033-2464
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Country | US
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Telephone | 323-987-1362
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Fax | 323-987-1365
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Provider Business Mailing Address
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Address Line | 1701 E CESAR E CHAVEZ AVE STE 510
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City | LOS ANGELES
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State | CA
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Zip | 90033-2488
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Country | US
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Telephone | 323-987-1362
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Fax | 323-987-1365
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3598
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License Number State | CA
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