Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1295801439 |
---|---|
Provider Name | Mrs. Ruby Lavon Matthews |
First Address | Carson, CA 90746-1726 |
Second Address | Long Beach, CA 90822-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |