Provider Demographics
NPI:1306220173
Name:MATKOWSKI, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MATKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 MEADOW VIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3467
Mailing Address - Country:US
Mailing Address - Phone:831-428-5016
Mailing Address - Fax:
Practice Address - Street 1:2125 MEADOW VIEW PL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3467
Practice Address - Country:US
Practice Address - Phone:831-428-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist