# LYDIA MATKOVICH, M.D. A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699710145
- **Authorized official:** DR. LYDIA MATKOVICH M.D. (OWNER)
- **Authorized official phone:** (310) 626-8055

## Contact information

- **Practice address:** 23600 TELO AVE, SUITE 210, TORRANCE, CA 90505-4035
- **Practice address phone:** (310) 626-8055
- **Practice address fax:** (310) 626-8058
- **Mailing address:** 23600 TELO AVE, SUITE 210, TORRANCE, CA 90505-4035
- **Mailing address phone:** (310) 626-8055
- **Mailing address fax:** (310) 626-8058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | G80774 | CA | Yes |

## Other

- **Enumeration date:** 06/18/2006
- **Last updated:** 03/05/2008