MEDICARE: WILLETT MEDICAL GROUP, P.C.

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1124951082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLETT MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	6812 CAMINITO SUENO
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-6001
Country	:	US
Telephone Number	:	760-846-4424
Fax Number	:	760-589-1029

Provider Business Practice Location Address
First Line	:	477 N EL CAMINO REAL STE C312
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-1328
Country	:	US
Telephone Number	:	760-846-4424
Fax Number	:	760-589-1029

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MATTHEW WILLETT
Credential	:	MD
Telephone Number	:	760-846-4424

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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