Provider Demographics
NPI:1154719870
Name:ROUSSEAU, MATHIEU (MD)
Entity type:Individual
Prefix:DR
First Name:MATHIEU
Middle Name:
Last Name:ROUSSEAU
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 1:825 E EVELYN AVE
Mailing Address - Street 2:APT. 118
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6533
Mailing Address - Country:US
Mailing Address - Phone:650-861-7757
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE
Practice Address - Street 2:STANFORD MEDICAL CENTER - THORACIC SURGERY
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5407
Practice Address - Country:US
Practice Address - Phone:650-861-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132009390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program