Provider Demographics
NPI:1093600025
Name:CORPUZ, MATTHEW BENEDICT
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BENEDICT
Last Name:CORPUZ
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 1:6925 CATABA RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92344-8661
Mailing Address - Country:US
Mailing Address - Phone:323-702-9730
Mailing Address - Fax:
Practice Address - Street 1:12188 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5822
Practice Address - Country:US
Practice Address - Phone:760-477-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-NDTXEW175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist