Provider Demographics
NPI:1134192842
Name:HOUSE, MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:HOUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1322 E SHAW AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-0000
Mailing Address - Country:US
Mailing Address - Phone:559-226-1316
Mailing Address - Fax:559-226-1315
Practice Address - Street 1:1322 E SHAW AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-0000
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:559-226-1315
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A78882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7888OtherCA STATE MEDICAL LICENSE
BH6923773OtherDEA NUMBER
H76941Medicare UPIN
020A78884Medicare PIN