Provider Demographics
NPI:1487891636
Name:MATHENEY, CHARLI A (BA, MA)
Entity type:Individual
Prefix:MS
First Name:CHARLI
Middle Name:A
Last Name:MATHENEY
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:MATHENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, MA
Mailing Address - Street 1:422 N FIRST ST
Mailing Address - Street 2:UNIT D
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2417
Mailing Address - Country:US
Mailing Address - Phone:626-308-3453
Mailing Address - Fax:
Practice Address - Street 1:1701 CAMINO PALMERO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2902
Practice Address - Country:US
Practice Address - Phone:323-875-0550
Practice Address - Fax:323-876-0439
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator