Provider Demographics
NPI:1790322410
Name:POSADAS, MATTHEW MERCADO (PT DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MERCADO
Last Name:POSADAS
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 SULLIVAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5030
Mailing Address - Country:US
Mailing Address - Phone:805-298-6288
Mailing Address - Fax:
Practice Address - Street 1:30230 RANCHO VIEJO RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1569
Practice Address - Country:US
Practice Address - Phone:949-461-1250
Practice Address - Fax:949-429-5999
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist