MEDICARE: MARCIA MATIKA DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E3497	CA

General Provider Information

NPI Number	:	1679593412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA MATIKA DPM

Provider Business Mailing Address
First Line	:	500 S SEPULVEDA BLVD
Second Line	:	STE 303
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6977
Country	:	US
Telephone Number	:	310-530-5729
Fax Number	:	310-530-5707

Provider Business Practice Location Address
First Line	:	500 S SEPULVEDA BLVD
Second Line	:	STE 303
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6977
Country	:	US
Telephone Number	:	310-530-5729
Fax Number	:	310-530-5707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	04/24/2017

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