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NPI Code Detail

MEDICARE: MATTHEW CARROLL

MEDICARE: MATTHEW CARROLL
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95038104CA

General Provider Information

NPI Number : 1326907403
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW CARROLL
Provider Business Mailing Address
First Line : 1849 SAWTELLE BLVD STE 610
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7013
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1849 SAWTELLE BLVD STE 610
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7013
Country : US
Telephone Number : 310-386-5470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ MATTHEW CARROLL ” Practice Location

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