MEDICARE: CLARE MATRIX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190016BN	OTHER	CA	STATE LICENSE
2	190016PN	OTHER	CA	DHCS-AOD STATE LICENSE

General Provider Information

NPI Number	:	1043537913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARE MATRIX

Provider Business Mailing Address
First Line	:	909 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1326
Country	:	US
Telephone Number	:	310-314-6200
Fax Number	:	310-450-2024

Provider Business Practice Location Address
First Line	:	907-909 PICO BLVD.
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1326
Country	:	US
Telephone Number	:	310-314-6200
Fax Number	:	310-450-2024

Authorized Official
Title or Position	:	EXECUTIVE OFFICER
Name	:	MATT WALTON
Credential	:
Telephone Number	:	310-314-6200

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	09/20/2024

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1063632230 — DARLENE GUTIERREZ
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Directions to “CLARE MATRIX ” Practice Location

Language	Start Address	Practice Location

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