Provider Demographics
NPI:1699043513
Name:MCPHETRIDGE, MATTHEW KEITH (LVN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KEITH
Last Name:MCPHETRIDGE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 KATELLA AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3500
Mailing Address - Country:US
Mailing Address - Phone:714-503-6850
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:714-503-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234186164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse