Provider Demographics
NPI:1154537348
Name:MATEO, ROGER P (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:P
Last Name:MATEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1907
Mailing Address - Country:US
Mailing Address - Phone:650-462-2800
Mailing Address - Fax:
Practice Address - Street 1:231 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1907
Practice Address - Country:US
Practice Address - Phone:650-321-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG037155102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46979Medicare UPIN
CA00G371550Medicare PIN