Individual
VADYM MATUSOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 300-8800
Mailing address
833 S ROSE ST, TURLOCK, CA 95380-5531
(818) 599-6960
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95070466
CA
164X00000X
Licensed Vocational Nurse
VN 235920
CA
Other
Enumeration date
07/24/2015
Last updated
07/15/2016
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