Provider Demographics
NPI:1740379072
Name:MATOSSIAN, CHERYL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:MATOSSIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4989 GOLDEN FOOTHILL PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9639
Mailing Address - Country:US
Mailing Address - Phone:916-941-7362
Mailing Address - Fax:866-779-3899
Practice Address - Street 1:4989 GOLDEN FOOTHILL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9639
Practice Address - Country:US
Practice Address - Phone:916-941-7362
Practice Address - Fax:866-779-3899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64163207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH30924Medicare UPIN