Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | G39658 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | G39658 | CA |
NPI | 1063629673 |
---|---|
Provider Name | David Matlock |
First Address | Los Angeles, CA 90069-3705 |
Second Address | Los Angeles, CA 90069-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |