Provider Demographics
NPI:1811564925
Name:FERRIN, MATTHEW
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:FERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:FERRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3245 S SEPULVEDA BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4210
Mailing Address - Country:US
Mailing Address - Phone:805-279-2072
Mailing Address - Fax:
Practice Address - Street 1:714 TIVERTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8361
Practice Address - Country:US
Practice Address - Phone:310-825-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-04-17
Deactivation Date:2024-04-03
Deactivation Code:
Reactivation Date:2024-04-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
905232463OtherUCLA