Provider Demographics
NPI:1851843775
Name:PETER MATTAR INC.
Entity Type:Organization
Organization Name:PETER MATTAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:909-973-7772
Mailing Address - Street 1:15076 CANON LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5211
Mailing Address - Country:US
Mailing Address - Phone:909-973-7772
Mailing Address - Fax:
Practice Address - Street 1:1901 TOWN AND COUNTRY DR
Practice Address - Street 2:STE. 104
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3611
Practice Address - Country:US
Practice Address - Phone:909-973-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CAA97235315D00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient