Provider Demographics
NPI:1093182610
Name:MILBURN-MATHEWS, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:MILBURN-MATHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FULTON ST APT D
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4221
Mailing Address - Country:US
Mailing Address - Phone:415-513-8389
Mailing Address - Fax:
Practice Address - Street 1:303 VAN BUREN
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610
Practice Address - Country:US
Practice Address - Phone:510-268-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator