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NPI Code Detail

MEDICARE: MATTHEW ALAN MCCULLOUGH M.D.

MEDICARE: MATTHEW ALAN MCCULLOUGH M.D.
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
1207R00000XInternal Medicine PhysicianA128263CA

General Provider Information

NPI Number : 1679839732
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW ALAN MCCULLOUGH M.D.
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD SUITE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90095-5631
Country : US
Telephone Number : 310-301-8707
Fax Number : 310-301-8751
Provider Business Practice Location Address
First Line : 27235 TOURNEY RD STE 2500
Second Line :
City : VALENCIA
State : CA
Zip : 91355-5908
Country : US
Telephone Number : 661-253-5851
Fax Number : 661-535-5852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2012
Last Update Date : 02/04/2022

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