Individual
DR. GLENN PAUL MATNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12402 INDUSTRIAL BLVD STE B1, VICTORVILLE, CA 92395-5889
(760) 245-9363
Mailing address
12402 INDUSTRIAL BLVD STE B1, VICTORVILLE, CA 92395-5889
(760) 245-9363
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
G069064
CA
208000000X
Pediatrics Physician
Primary
G069064
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
G069064
CA
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
G069064
CA
2084P0802X
Addiction Psychiatry Physician
G69064
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G690641 8757126
—
CA
Enumeration date
07/14/2006
Last updated
08/10/2019
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