Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | C168510 | CA |
N | 207SG0201X | Clinical Genetics (M.D.) | MD421927 | PA |
N | 208000000X | Pediatrician | MD421927 | PA |
NPI | 1164541181 |
---|---|
Provider Name | Dr. Matthew Deardorff |
First Address | Los Angeles, CA 90027-6062 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 30/04/2020 |