Basic Information
| Provider Information | |||||||||
| NPI: | 1972525343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATORIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 231189 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920231189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602302251 | ||||||||
| FaxNumber: | 7602302253 | ||||||||
| Practice Location | |||||||||
| Address1: | 354 SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602302251 | ||||||||
| FaxNumber: | 7602302253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A82730 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 174400000X | A82730 | CA | N | Other Service Providers | Specialist | 207R00000X | A82730 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A8273000 | 05 | CA | MEDICAID |