Basic Information
| Provider Information | |||||||||
| NPI: | 1124117700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOTHERN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | ROLAND | ||||||||
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| Credential: | NP PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E HILL STREET | ||||||||
| Address2: | |||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907553682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624246200 | ||||||||
| FaxNumber: | 5624274634 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 LONG BEACH BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | LONG BECH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908065062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629816865 | ||||||||
| FaxNumber: | 5625956471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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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 | 363A00000X | A16544 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | 13855 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.