Individual
MATTHEW S ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
13320 RIVERSIDE DR STE 214, SHERMAN OAKS, CA 91423-2512
(818) 621-0019
Mailing address
13320 RIVERSIDE DR STE 214, SHERMAN OAKS, CA 91423-2512
(818) 621-0019
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
20A12283
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
20A12283
CA
208VP0014X
Interventional Pain Medicine Physician
Primary
20A12283
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12373066
CAQH PROVIDER NUMBER
CA
Enumeration date
09/27/2011
Last updated
11/07/2022
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