Provider Demographics
NPI:1720585797
Name:MATTHEW M. SCHULTZEL, DO, AN OSTEOPATHIC MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MATTHEW M. SCHULTZEL, DO, AN OSTEOPATHIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SCHULTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-232-2154
Mailing Address - Street 1:9850 GENESEE AVE STE 570
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1229
Mailing Address - Country:US
Mailing Address - Phone:858-207-3117
Mailing Address - Fax:951-698-0272
Practice Address - Street 1:9850 GENESEE AVE STE 570
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:760-635-9185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11955208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty