Provider Demographics
NPI:1225073307
Name:MATTU, MUHAMMAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:A
Last Name:MATTU
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 1:1908 COFFEE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2719
Mailing Address - Country:US
Mailing Address - Phone:209-846-9429
Mailing Address - Fax:
Practice Address - Street 1:1908 COFFEE RD STE 3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2719
Practice Address - Country:US
Practice Address - Phone:209-846-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29499207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-6000524OtherCOUNTY OF MONTEREY NMC
CAHSP40248FMedicaid
CA94-6000524OtherCOUNTY OF MONTEREY NMC
CAA29499Medicare UPIN