Provider Demographics
NPI:1194022665
Name:HUOVINEN, MATHIEU WILSON (IDC)
Entity Type:Individual
Prefix:
First Name:MATHIEU
Middle Name:WILSON
Last Name:HUOVINEN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3958 IOWA ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3057
Mailing Address - Country:US
Mailing Address - Phone:910-619-2952
Mailing Address - Fax:
Practice Address - Street 1:3958 IOWA ST UNIT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3057
Practice Address - Country:US
Practice Address - Phone:910-619-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman