Provider Demographics
NPI:1518617711
Name:MATTER, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MATTER
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 1:342 S PUENTE ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5259
Mailing Address - Country:US
Mailing Address - Phone:626-774-6877
Mailing Address - Fax:
Practice Address - Street 1:342 S PUENTE ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5259
Practice Address - Country:US
Practice Address - Phone:626-774-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician