Organization
HARRY B. MATOSSIAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARRY BERJ MATOSSIAN M.D. (OWNER)
(707) 462-3190
Entity
Organization
Contact information
Practice address
234 HOSPITAL DR, UKIAH, CA 95482-4560
(707) 462-3190
(707) 462-4647
Mailing address
234 HOSPITAL DR, SUITE A, UKIAH, CA 95482-4560
(707) 462-3190
(707) 462-4647
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1100514
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-C0001639
MEDICARE LICENSE NUMBER
CA
01
—
AS1639
BLUE CROSS OF CALIFORNIA
CA
01
—
P00117803
RAILROAD MEDICARE
CA
01
—
ZZZH23012
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/12/2005
Last updated
09/23/2014
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