Provider Demographics
NPI:1386637023
Name:MATLOF, HARVEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
Last Name:MATLOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2800 L ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-887-4040
Practice Address - Fax:916-887-4045
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30885207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C308850Medicaid
CAP00084697OtherRAILROAD MEDICARE PIN
CAP00084697OtherRAILROAD MEDICARE PIN
CA00C308853Medicare PIN
CA00C308852Medicare PIN