Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A124846 | CA |
N | 207T00000X | Neurosurgeon | MD421707 | PA |
NPI | 1033368998 |
---|---|
Provider Name | Dr. Julian Antony Mattiello |
First Address | Los Angeles, CA 90048-3503 |
Second Address | Los Angeles, CA 90048-6101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 03/04/2013 |