Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A120256 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | ME119656 | FL |
NPI | 1063612802 |
---|---|
Provider Name | Dr. Matthew Jordan Nykiel |
First Address | Upland, CA 91786-2803 |
Second Address | Upland, CA 91786-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 24/02/2021 |