Provider Demographics
NPI:1003991431
Name:MATIN, ALIASGHAR (MD,RPT)
Entity Type:Individual
Prefix:
First Name:ALIASGHAR
Middle Name:
Last Name:MATIN
Suffix:
Gender:M
Credentials:MD,RPT
Other - Prefix:
Other - First Name:ALIASGHAR
Other - Middle Name:
Other - Last Name:MATIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDRPT
Mailing Address - Street 1:1407 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2416
Mailing Address - Country:US
Mailing Address - Phone:818-308-7450
Mailing Address - Fax:818-308-7795
Practice Address - Street 1:5635 CAHUENGA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2104
Practice Address - Country:US
Practice Address - Phone:818-308-7450
Practice Address - Fax:818-308-7795
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97751208100000X
CAPT 12456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA170185Medicare UPIN