Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 95005723 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95005723 | CA |
NPI | 1629514245 |
---|---|
Provider Name | Matthew Nagtalon |
First Address | San Pedro, CA 90731-1339 |
Second Address | Fullerton, CA 92835-3809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2017 |
Last Update Date | 23/06/2021 |