Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A160670 | CA |
N | 207T00000X | Neurosurgeon | MT202574 | PA |
NPI | 1043573959 |
---|---|
Provider Name | Matthew Piazza |
First Address | Walnut Creek, CA 94598-3045 |
Second Address | Walnut Creek, CA 94598-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A160670 | MEDICAL LICENSE (01) | CA |