Provider Demographics
NPI:1679223663
Name:ADVENTIST FAMILY MEDICINE RESIDENCY TULARE
Entity Type:Organization
Organization Name:ADVENTIST FAMILY MEDICINE RESIDENCY TULARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:408-332-9879
Mailing Address - Street 1:2059 HILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-1609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2059 HILLMAN ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-1609
Practice Address - Country:US
Practice Address - Phone:559-605-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty