Provider Demographics
NPI:1477973907
Name:PAUL, MATTHEW DARNELL (MSPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DARNELL
Last Name:PAUL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 STERLING PKWY
Mailing Address - Street 2:STE 150
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7326
Mailing Address - Country:US
Mailing Address - Phone:916-543-7900
Mailing Address - Fax:
Practice Address - Street 1:801 STERLING PKWY
Practice Address - Street 2:STE 150
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7326
Practice Address - Country:US
Practice Address - Phone:916-543-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40862174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist