Provider Demographics
NPI:1487767265
Name:MATHIAS, HERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 N SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3118
Mailing Address - Country:US
Mailing Address - Phone:951-929-6003
Mailing Address - Fax:951-929-9786
Practice Address - Street 1:391 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3118
Practice Address - Country:US
Practice Address - Phone:951-929-6003
Practice Address - Fax:951-929-9786
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41055207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29286Medicare UPIN
CA00A401552Medicare ID - Type Unspecified