Provider Demographics
NPI:1518014216
Name:FREEMAN, MATTHEW BRET (LAC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRET
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16161 VENTURA BLVD STE 227
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2572
Mailing Address - Country:US
Mailing Address - Phone:818-788-2884
Mailing Address - Fax:818-788-0507
Practice Address - Street 1:16161 VENTURA BLVD STE 227
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2572
Practice Address - Country:US
Practice Address - Phone:818-788-2884
Practice Address - Fax:818-788-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist