Provider Demographics
NPI:1740429216
Name:JOSEPH ANTHONY MATAN M.D. A PROFESSIONAL CORPORATION.
Entity Type:Organization
Organization Name:JOSEPH ANTHONY MATAN M.D. A PROFESSIONAL CORPORATION.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MATAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-724-4300
Mailing Address - Street 1:1700 SAN PABLO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2081
Mailing Address - Country:US
Mailing Address - Phone:510-724-4300
Mailing Address - Fax:510-964-0607
Practice Address - Street 1:1700 SAN PABLO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2081
Practice Address - Country:US
Practice Address - Phone:510-724-4300
Practice Address - Fax:510-964-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G119520207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G119520Medicaid
CAA38495Medicare UPIN
CA1568450146Medicare NSC