Provider Demographics
NPI:1336642610
Name:MATHEWS, ABRAHAM
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:MATHEWS
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 1:1009 MEPHAM DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3771
Mailing Address - Country:US
Mailing Address - Phone:415-574-5420
Mailing Address - Fax:
Practice Address - Street 1:1009 MEPHAM DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3771
Practice Address - Country:US
Practice Address - Phone:415-574-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician