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General NPI Number Information
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NPI Number | 1902038326
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Entity Type | Organization
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Legal Business Name | SOUTHLAND SPINE & REHABILITATION MED CTR
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 4354 LATHAM ST STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92501-1777
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Country | US
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Telephone | 951-275-5888
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Fax | 951-275-5887
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Provider Business Mailing Address
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Address Line | 4354 LATHAM ST STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92501-1777
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Country | US
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Telephone | 951-275-5888
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Fax | 951-275-5887
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | MAX MATOS
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Credential | M.D.
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Telephone | 95127525888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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