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General NPI Number Information
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NPI Number | 1962682914
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Entity Type | Individual
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Provider Name | MATTHEW LEE MEDICUS
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Gender | Male
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 330 W FELICITA AVE SUITE A4
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City | ESCONDIDO
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State | CA
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Zip | 92025-6530
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Country | US
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Telephone | 760-489-1323
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Fax | 760-489-0975
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Provider Business Mailing Address
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Address Line | 5000 CHESHIRE LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3706
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Country | US
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Telephone | 888-333-9152
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Fax | 763-268-4240
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA7300
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License Number State | CA
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