Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0000000000000 | LA |
NPI | 1003134560 |
---|---|
Provider Name | Dr. Matthew John Sexter |
First Address | Los Angeles, CA 90028-6213 |
Second Address | Los Angeles, CA 90028-6213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2010 |
Last Update Date | 10/04/2017 |