Basic Information
| Provider Information | |||||||||
| NPI: | 1033368998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTIELLO | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | ANTONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 1/2 N HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900483503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108362382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8635 W 3RD ST | ||||||||
| Address2: | SUITE 1080 WEST | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900486101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104239900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | MD421707 | PA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | A124846 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.