Provider Demographics
NPI:1124241070
Name:OLIN, MATTHEW SIDNEY (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SIDNEY
Last Name:OLIN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3445 PCH HWY
Mailing Address - Street 2:STE 220
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6660
Mailing Address - Country:US
Mailing Address - Phone:310-534-9100
Mailing Address - Fax:310-534-9112
Practice Address - Street 1:25775 MCBEAN PKWY STE 212
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3703
Practice Address - Country:US
Practice Address - Phone:661-254-7200
Practice Address - Fax:661-254-8204
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18578363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant