Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A12283 | CA |
N | 2081P2900X | Pain Medicine | 20A12283 | CA |
NPI | 1043593098 |
---|---|
Provider Name | Matthew S Root |
First Address | North Hollywood, CA 91602-2159 |
Second Address | North Hollywood, CA 91602-2159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2011 |
Last Update Date | 30/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12373066 | CAQH PROVIDER NUMBER (01) | CA |