Provider Demographics
NPI:1326707480
Name:PALL, MATTHEW (NRP, CP-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:PALL
Suffix:
Gender:M
Credentials:NRP, CP-C
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 7741
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7741
Mailing Address - Country:US
Mailing Address - Phone:818-390-9444
Mailing Address - Fax:
Practice Address - Street 1:80 E HILLCREST DR STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4226
Practice Address - Country:US
Practice Address - Phone:818-390-9444
Practice Address - Fax:818-381-0007
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22-CCHW-00000172V00000X
CA172V00000X
CAP32875146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No172V00000XOther Service ProvidersCommunity Health Worker