Provider Demographics
NPI:1073870549
Name:MATTEUCCI, TOM DOUGLAS (ND)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:DOUGLAS
Last Name:MATTEUCCI
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 STATE ST # 206
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2717
Mailing Address - Country:US
Mailing Address - Phone:805-560-0111
Mailing Address - Fax:805-258-5132
Practice Address - Street 1:1114 STATE ST STE 206
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2717
Practice Address - Country:US
Practice Address - Phone:805-560-0111
Practice Address - Fax:805-258-5132
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-519175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath