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Individual

DR. MATTHEW HADILAKSONO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1105 LAS TABLAS RD STE D, TEMPLETON, CA 93465-9731
(805) 550-6689
(833) 615-2271
Mailing address
128 LA COLIMA, PISMO BEACH, CA 93449-2841
(310) 500-7966

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
20A15470
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
20A15470
CA

Other

Enumeration date
01/15/2015
Last updated
03/01/2022
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