Provider Demographics
NPI:1285635144
Name:AHMADI, MATT M (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:M
Last Name:AHMADI
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:26800 CROWN VALLEY PARKWAY
Mailing Address - Street 2:STE 320
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-276-8900
Mailing Address - Fax:949-276-8901
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:STE 320
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-276-8900
Practice Address - Fax:949-276-8901
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE4539213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE4539AMedicare PIN
CAV00818Medicare UPIN