1396303756 NPI number — DR. MATTHEW PALEY DO

Table of content: DR. MATTHEW PALEY DO (NPI 1396303756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396303756 NPI number — DR. MATTHEW PALEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALEY
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396303756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91944-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-464-1165
Provider Business Mailing Address Fax Number:
619-567-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 REDWOOD HWY
Provider Second Line Business Practice Location Address:
STE 332
Provider Business Practice Location Address City Name:
MILL VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94941-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-214-6655
Provider Business Practice Location Address Fax Number:
279-300-3958
Provider Enumeration Date:
05/31/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  BP10067069 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 20A19906 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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