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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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1710455209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW CARROLL
Provider Business Mailing Address
First Line : 1316 S COAST HWY
Second Line :
City : LAGUNA BEACH
State : CA
Zip : 92651-3118
Country : US
Telephone Number : 626-828-9152
Fax Number :
Provider Business Practice Location Address
First Line : 1316 S COAST HWY
Second Line :
City : LAGUNA BEACH
State : CA
Zip : 92651-3118
Country : US
Telephone Number : 626-828-9152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 06/30/2023

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Directions to “ MATTHEW CARROLL ” Practice Location

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