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NPI Code Detail

MEDICARE: DR. TARANEH MATIN D.O.

MEDICARE: DR. TARANEH MATIN D.O.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207N00000XDermatology Physician20A20604CA

General Provider Information

NPI Number : 1528508876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARANEH MATIN D.O.
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 714-443-4512
Fax Number :
Provider Business Practice Location Address
First Line : 675 S ARROYO PKWY
Second Line :
City : PASADENA
State : CA
Zip : 91105-3263
Country : US
Telephone Number : 626-585-4120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2017
Last Update Date : 03/09/2026

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