Provider Demographics
NPI:1174537104
Name:PELTZ, MATTHEW J (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:PELTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 994032
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4032
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:1832 BUENAVENTURA BLVD
Practice Address - Street 2:STE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3700
Practice Address - Country:US
Practice Address - Phone:530-229-1310
Practice Address - Fax:530-229-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX63840Medicaid
CAF91674Medicare UPIN
CA00AX63840Medicaid