Provider Demographics
NPI:1073051835
Name:MATUTE, JORAM MICHAEL (MA)
Entity Type:Individual
Prefix:MR
First Name:JORAM
Middle Name:MICHAEL
Last Name:MATUTE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15643 SHERMAN WAY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4135
Mailing Address - Country:US
Mailing Address - Phone:626-531-6999
Mailing Address - Fax:
Practice Address - Street 1:500 S LOS ROBLES AVE
Practice Address - Street 2:APT 305
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3266
Practice Address - Country:US
Practice Address - Phone:805-390-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator