Provider Demographics
NPI:1659477768
Name:MATLOFF, JEFFREY LEWIS (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEWIS
Last Name:MATLOFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CIVIC CENTER DR STE 116
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6034
Mailing Address - Country:US
Mailing Address - Phone:760-585-6490
Mailing Address - Fax:
Practice Address - Street 1:140 CIVIC CENTER DR STE 116
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6034
Practice Address - Country:US
Practice Address - Phone:760-585-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5860103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist