Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G24191 | CA |
NPI | 1134277098 |
---|---|
Provider Name | Philip D. Mattson |
First Address | San Diego, CA 92120-2507 |
Second Address | San Diego, CA 92120-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 23/09/2008 |