Provider Demographics
NPI:1306030788
Name:KIZZIE, MATTHEW L (CONSERVATOR)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:KIZZIE
Suffix:
Gender:M
Credentials:CONSERVATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-0140
Mailing Address - Country:US
Mailing Address - Phone:916-876-5523
Mailing Address - Fax:916-875-3188
Practice Address - Street 1:3331 POWER INN RD
Practice Address - Street 2:SUITE 450
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-876-5523
Practice Address - Fax:916-875-3188
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator