Provider Demographics
NPI:1235350836
Name:GARGULINSKI, MATTHEW JON (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JON
Last Name:GARGULINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 WEST GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-668-2630
Mailing Address - Fax:530-668-4777
Practice Address - Street 1:632 WEST GIBSON RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-668-2630
Practice Address - Fax:530-668-4777
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9757174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00745187OtherMEDICARE RAILROAD
CA20A9757OtherMEDICAL LICENSE
CA20A9757OtherMEDICAL LICENSE