| Mousa Matar MD Inc | |
|
4440 Brockton Ave Ste 100 Riverside CA 92501-4026 | |
| (773) 814-8200 | |
| (951) 788-6380 |
| Full Name | Mousa Matar MD Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4440 Brockton Ave Ste 100, Riverside, California |
| Authorized Official Name and Position | Mousa Matar (MD) |
| Authorized Official Contact | 7738148200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mousa Matar MD Inc Po Box 1810 Upland CA 91785-1810 Ph: (773) 814-8200 | Mousa Matar MD Inc 4440 Brockton Ave Ste 100 Riverside CA 92501-4026 Ph: (773) 814-8200 |
| NPI Number | 1558094904 |
|---|---|
| Provider Enumeration Date | 07/05/2022 |
| Last Update Date | 02/20/2023 |
| Certification Date | 02/20/2023 |
| Medicare PECOS PAC ID | 5597133843 |
|---|---|
| Medicare Enrollment ID | O20221117003082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558094904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Mousa Matar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992116982 PECOS PAC ID: 2567737026 Enrollment ID: I20210907001912 |
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