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NPI Code Detail

MEDICARE: MATRIX MEDICAL CORPORATION

MEDICARE: MATRIX MEDICAL CORPORATION
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
1207V00000XObstetrics & Gynecology PhysicianG29754CA

General Provider Information

NPI Number : 1770644239
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATRIX MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 1304 ELLA ST.
Second Line : SUITE A
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4165
Country : US
Telephone Number : 805-541-1060
Fax Number : 805-541-6942
Provider Business Practice Location Address
First Line : 1304 ELLA ST.
Second Line : SUITE A
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4165
Country : US
Telephone Number : 805-541-1060
Fax Number : 805-541-6942
Authorized Official
Title or Position : OWNER
Name : GEORGE EDWARD JOHNSON JR.
Credential : MD
Telephone Number : 805-541-1060
Provider Enumeration Date : 12/12/2006
Last Update Date : 08/22/2020

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Directions to “MATRIX MEDICAL CORPORATION ” Practice Location

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