Provider Demographics
NPI:1164423604
Name:MATLES, HARLAN (MD)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:
Last Name:MATLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94027-4110
Mailing Address - Country:US
Mailing Address - Phone:650-391-0500
Mailing Address - Fax:
Practice Address - Street 1:1706 EL CAMINO REAL
Practice Address - Street 2:SUITE #200
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94027-4127
Practice Address - Country:US
Practice Address - Phone:650-391-0500
Practice Address - Fax:650-391-0503
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH72518Medicare UPIN