Provider Demographics
NPI:1326049149
Name:MATEZ, ALAN MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARTIN
Last Name:MATEZ
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 1:2333 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3607
Mailing Address - Country:US
Mailing Address - Phone:619-297-5468
Mailing Address - Fax:619-297-0351
Practice Address - Street 1:2333 CAMINO DEL RIO S
Practice Address - Street 2:SUITE100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3607
Practice Address - Country:US
Practice Address - Phone:619-297-5468
Practice Address - Fax:619-297-0351
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3756207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A3756Medicaid
CAE18126Medicare UPIN
CA20A3756Medicare ID - Type Unspecified