Provider Demographics
NPI:1851027056
Name:AMEER MATARIYEH A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AMEER MATARIYEH A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIDULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-471-2235
Mailing Address - Street 1:44938 16TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2135
Mailing Address - Country:US
Mailing Address - Phone:661-471-2235
Mailing Address - Fax:661-750-4292
Practice Address - Street 1:1990 WESTWOOD BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4674
Practice Address - Country:US
Practice Address - Phone:310-475-5377
Practice Address - Fax:310-446-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty