Provider Demographics
NPI:1932538121
Name:MATECKI, WAYNE (L AC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:MATECKI
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20482
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94820-0482
Mailing Address - Country:US
Mailing Address - Phone:510-669-9888
Mailing Address - Fax:510-758-5631
Practice Address - Street 1:448 VALLEY VIEW ROAD SUITE B
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803
Practice Address - Country:US
Practice Address - Phone:510-669-9888
Practice Address - Fax:510-758-5631
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist