Provider Demographics
NPI:1659325488
Name:MATTHEWS, ADORA L (MD)
Entity Type:Individual
Prefix:
First Name:ADORA
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1329 HOWE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3363
Mailing Address - Country:US
Mailing Address - Phone:916-678-6760
Mailing Address - Fax:916-678-6761
Practice Address - Street 1:6 MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-781-1000
Practice Address - Fax:843-673-7336
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18023208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7906300Medicaid
SC180235Medicaid
SCG09974Medicare UPIN
NC7906300Medicaid
SC180235Medicaid