Dr. Glenn Paul Matney
Pediatrician Family Doctor - Addiction Medicine
12402 Industrial Blvd Ste B1
Victorville
, California 92395-5889
Dr. Glenn Paul Matney
Pediatrician Family Doctor - Addiction Medicine
12402 Industrial Blvd Ste B1
Victorville
, California 92395-5889
(760) 245-9363
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About
Features
Specialties
- Family Doctor - Addiction Medicine
- Pediatrician
Languages spoken
- English
Location
First Address
- Dr. Glenn Paul Matney
- 12402 Industrial Blvd Ste B1
- Victorville, CA
- Zip : 92395-5889
- Phone : (760) 245-9363
Second Address
- Dr. Glenn Paul Matney
- 12402 Industrial Blvd Ste B1
- Victorville, CA
- Zip : 92395-5889
- Phone : (760) 245-9363
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207QA0401X | Family Doctor - Addiction Medicine | G069064 | CA |
| Y | 208000000X | Pediatrician | G069064 | CA |
National Provider Identifier
| NPI | 1902822059 |
|---|---|
| Provider Name | Dr. Glenn Paul Matney |
| First Address | Victorville, CA 92395-5889 |
| Second Address | Victorville, CA 92395-5889 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/07/2006 |
| Last Update Date | 10/08/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00G690641 8757126 | (05) | CA |
| F21967 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.