Basic Information
Provider Information
NPI: 1689704355
EntityType: 2
ReplacementNPI:  
OrganizationName: JOEL M. MATTA, MD, INC.
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Mailing Information
Address1: 2001 SANTA MONICA BL
Address2: SUITE 760
City: SANTA MONICA
State: CA
PostalCode: 904042102
CountryCode: US
TelephoneNumber: 3105827475
FaxNumber: 3105827481
Practice Location
Address1: 2001 SANTA MONICA BLVD
Address2: SUITE 1090
City: SANTA MONICA
State: CA
PostalCode: 904042102
CountryCode: US
TelephoneNumber: 3105827475
FaxNumber: 3105827481
Other Information
ProviderEnumerationDate: 03/06/2007
LastUpdateDate: 07/30/2014
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AuthorizedOfficialLastName: MATTA
AuthorizedOfficialFirstName: JOEL
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3108527475
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XG27855CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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