Provider Demographics
NPI:1629538194
Name:GLENN P. MATNEY, M.D., INC.
Entity Type:Organization
Organization Name:GLENN P. MATNEY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-245-9363
Mailing Address - Street 1:12402 INDUSTRIAL BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5889
Mailing Address - Country:US
Mailing Address - Phone:760-245-9363
Mailing Address - Fax:760-245-5158
Practice Address - Street 1:12402 INDUSTRIAL BLVD STE B1
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5889
Practice Address - Country:US
Practice Address - Phone:760-245-9363
Practice Address - Fax:760-245-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty