Provider Demographics
NPI:1316395726
Name:LOUIS, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81767 DR CARREON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5599
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:41865 BOARDWALK STE 103
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9031
Practice Address - Country:US
Practice Address - Phone:760-391-5151
Practice Address - Fax:760-391-5159
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program