Organization
GLENN P. MATNEY, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN PAUL MATNEY MD (PRESIDENT)
(760) 245-9363
Entity
Organization
Contact information
Practice address
12402 INDUSTRIAL BLVD STE B1, VICTORVILLE, CA 92395-5889
(760) 245-9363
(760) 245-5158
Mailing address
12402 INDUSTRIAL BLVD STE B1, VICTORVILLE, CA 92395-5889
(760) 245-9363
(760) 245-5158
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
Other
Enumeration date
03/21/2019
Last updated
08/10/2019
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