Provider Demographics
NPI:1558094904
Name:MOUSA MATAR MD INC
Entity Type:Organization
Organization Name:MOUSA MATAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-814-8200
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1810
Mailing Address - Country:US
Mailing Address - Phone:773-814-8200
Mailing Address - Fax:951-750-1091
Practice Address - Street 1:4440 BROCKTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4026
Practice Address - Country:US
Practice Address - Phone:773-814-8200
Practice Address - Fax:951-788-6380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUSA MATAR MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-05
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty