Provider Demographics
NPI:1609502640
Name:SCHAFER, MATTHEW ALBERT
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALBERT
Last Name:SCHAFER
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 1:234 S 5TH AVE APT E
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2579
Mailing Address - Country:US
Mailing Address - Phone:510-517-0659
Mailing Address - Fax:
Practice Address - Street 1:234 S 5TH AVE APT E
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2579
Practice Address - Country:US
Practice Address - Phone:510-517-0659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant