Individual
DANIEL T MATULICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1165 MONTGOMERY DR, SANTA ROSA MEMORIAL HOSPITAL, SANTA ROSA, CA 95405-4801
(707) 552-1573
Mailing address
1165 MONTGOMERY DR, SANTA ROSA, CA 95405-4801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G48662
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G486620
—
CA
Enumeration date
06/15/2006
Last updated
09/10/2007
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