Provider Demographics
NPI:1881949808
Name:MATIAS, JANICE ANNE A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JANICE ANNE
Middle Name:A
Last Name:MATIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 LAUREL CANYON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3276
Mailing Address - Country:US
Mailing Address - Phone:818-596-5400
Mailing Address - Fax:
Practice Address - Street 1:6350 LAUREL CANYON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3276
Practice Address - Country:US
Practice Address - Phone:818-596-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant