Individual
DR. MATTHEW JAY WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
431 S BATAVIA ST STE 101, ORANGE, CA 92868-3937
(714) 363-3300
(714) 363-3847
Mailing address
431 S BATAVIA ST STE 101, ORANGE, CA 92868-3937
(714) 363-3300
(714) 363-3847
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
C55031
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69422834
—
NM
Enumeration date
03/09/2006
Last updated
03/04/2024
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