Provider Demographics
NPI:1487675815
Name:MATTHEWS, TROY BRUCE (PA)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:BRUCE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1242 WEST 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731
Mailing Address - Country:US
Mailing Address - Phone:206-658-5541
Mailing Address - Fax:360-537-6146
Practice Address - Street 1:5769 UPLANDER WAY FRIEDMAN PSYCHIATRY GROUP
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230
Practice Address - Country:US
Practice Address - Phone:310-337-9800
Practice Address - Fax:360-537-5004
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003943363A00000X
CA52521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ11157Medicare UPIN