Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A114981 | CA |
Y | 111NI0900X | Internist | A114981 | CA |
NPI | 1003142985 |
---|---|
Provider Name | Dr. Matthew James Roosevelt |
First Address | San Diego, CA 92120-0000 |
Second Address | San Diego, CA 92120-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2009 |
Last Update Date | 08/11/2021 |