Provider Demographics
NPI:1336379759
Name:MATSON, KAROL ANN (R D)
Entity Type:Individual
Prefix:MS
First Name:KAROL
Middle Name:ANN
Last Name:MATSON
Suffix:
Gender:F
Credentials:R D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18808 STONE CANYON LN
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5026
Mailing Address - Country:US
Mailing Address - Phone:253-306-4893
Mailing Address - Fax:
Practice Address - Street 1:732 MOTT ST
Practice Address - Street 2:SUITE150
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4237
Practice Address - Country:US
Practice Address - Phone:818-837-3775
Practice Address - Fax:818-837-3799
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered