Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | A42818 | CA |
N | 207RA0401X | Internist - Addiction Medicine | A42818 | CA |
Y | 208000000X | Pediatrician | A42818 | CA |
NPI | 1770503575 |
---|---|
Provider Name | Dr. Clare M Matney |
First Address | Victorville, CA 92395-5871 |
Second Address | Victorville, CA 92395-5871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 10/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A428180 | (05) | CA |
A29638 | (02) |