Basic Information
| Provider Information | |||||||||
| NPI: | 1780944470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKIS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23622 CALABASAS RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913021549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189214300 | ||||||||
| FaxNumber: | 8779173450 | ||||||||
| Practice Location | |||||||||
| Address1: | 23622 CALABASAS RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913021549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189214300 | ||||||||
| FaxNumber: | 8779173450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2012 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | R2147 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.